Variation in Subtypes of Obsessive-Compulsive Traits in Migraine Patients Undergoing Onabotulinum Toxin A Therapy

Background: Patients with chronic migraine (CM) associated with medication overuse headache (MOH) often exhibit concomitant psychiatric traits including obsessive-compulsive disorder (OCD). Limited data exist on the impact of migraine therapies on these traits. This study aimed to analyse the influence of onabotulinum toxin A (OBT-A) on OCD in CM + MOH patients. Methods: All CM + MOH patients attending the AOU-Marche Headache Centre and treated with OBT-A over a 9-month period were prospectively analysed. At baseline and every three months, patients completed several questionnaires, including the Obsessive-Compulsive Inventory-Revised (OCI-R), to assess the presence of OCD and its subscales. Results: Thirty patients were enrolled. Repeated measures tests revealed a statistically significant decrease from T0 to T3 in the OCI-R score (p = 0.017) and among the different subscales, specifically the checking score (p = 0.029). The MIDAS (migraine disability assessment score) and HIT-6 (headache impact test) scores exhibited a statistically significant reduction from T0 to T3 (p < 0.0001), similar to the decrease in monthly migraine days and symptomatic medication intake. Conclusions: Patients treated with OBT-A showed significant improvement in OCD, particularly in subscales assessing somatic and aggressive obsessions as well as control compulsions. Several patients transitioned from a CM + MOH condition to an episodic form without drug abuse. The potential impact of OBT-A on psychiatric symptoms warrants further consideration to improve patient management strategies.