Dependent personality trait, characterized by an individual’s psychological dependence on others, is associated with nonresponse to onabotulinumtoxin A (onabotA) in patients with chronic migraine, a study in Headache reports.

The findings were from a case-control observational study of patients with chronic migraine (ie, headache remaining ≥15 days per month, lasting 4 hours per day). A total of 112 patients with chronic migraine who had received ≥2 treatment cycles of onabotA in 2 different specialty headache units in 2018 were included in the study. Researchers assessed onabotA response, defined as the reduction of ≥50% in the number of monthly migraine days. Response to treatment was correlated with personality traits, the latter of which were assessed using a validated categoric inventory of 11 personality traits (Salamanca questionnaire).

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In the overall cohort, the mean duration of chronic migraine was 29 months, and the mean age at onset of treatment with onabotA was 43 years. In cluster A, the distribution of personality traits included 10.7% for paranoid, 38.4% for schizoid, and 7.1% for schizotypal. The distribution of personality traits in the cluster B group consisted of 50% histrionic, 1.8% antisocial, 9.8% narcissistic, 27.7% emotional instability subtype impulsive, and 24.1% emotional instability subtype limit (EISL). Those in the cluster C group had 58.9% anxious, 54.5% anankastic, and 32.1% dependent personality traits.

Approximately 85.7% (n=96) of patients achieved an onabotA response. While the univariate analysis found an association between nonresponse to onabotA and dependent personality (P =.005) and emotional instability subtype limit (P =.022), the final multivariable analysis revealed dependent trait to be the only significant predictor of nonresponse (odds ratio, 0.223; 95% CI, 0.074-0.675; P =.008).


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Limitations of the study included the absence of a healthy control group, the small sample size, and the lack of peer-review of the Salamanca screening test.

The researchers concluded that clinicians may wish to consider “conducting an evaluation of personality traits in patients with chronic migraine” to assist “in the prediction of the course and election of the treatment.”

Reference

Gonzalez-Martinez A, Rodríguez Vázquez E, de la Red Gallego H, et al. Association between personality traits and onabotulinumtoxin A response in patients with chronic migraine [published online November 6, 2019]. Headache. doi:10.1111/head.13693