The Repeater Phenomenon in Migraine Patients: A Clinical and Psychometric study

Background.- Headache is one of the most common symptoms in an emergency department (ED), while migraine is the most frequently observed headache in this setting. The aim of our study was to evaluate the influence of clinical and psychometric variables on the repeater phenomenon, ie, patients who make at least 3 visits to the ED at least 1 week apart during a 6-month period. Methods.- According to the International Classification of Headache Disorders, 2nd edition (ICHD-II) criteria, we consecutively recruited Italian-speaking migraine subjects who came to the ED or outpatient service. All the patients underwent the Migraine Disability Assessment Scale for the evaluation of migraine disability. We also administered the Beck Depression Inventory, State and Trait Anxiety Inventory, and Toronto Alexithymia Scale-20 for the evaluation of depressive, anxiety, and alexithymic symptoms, respectively. A personality profile was also obtained by means of the Tridimensional Personality Questionnaire (TPQ). Results.- We consecutively enrolled 465 migraine patients, diagnosed according to the ICHD-II criteria. Seventy (15%) of these patients met the repeater definition. The repeater group had more severe disability and was affected to a greater degree by chronic migraine, regardless of symptomatic drug overuse, than the non-repeater group. As regards the psychometric variables, repeaters were more alexithymic, anxious, and depressed than non-repeaters. The personality profile, as measured by the TPQ, revealed that the repeater patients scored higher on the harm avoidance scale and their subscales than the non-repeater patients. Conclusions.- According to the findings of our study, the repeater migraineur is typically triptan-naive, more alexithymic, and more depressed than the non-repeater migraineur. A clinical and psychometric evaluation of repeater patients who go to the ED because of migraine attacks may help to understand this epidemiological and clinical phenomenon. From a clinical point of view, these psychometric findings may not only shed light on the epidemiology of migraine in the ED, but may also help to design a specific therapeutic protocol for this subgroup of migraine patients.