Mental Health Intervention of Migraine Patients by Psychotherapy

The present study attempts to examine the effect of Psychotherapy on migraine patients. 100 patients were consisted for this study out of these 50- treated and 50 non-treated patients were evaluated at S Mental & Physical Health Society (SIMPHS), Varanasi (India). The two groups were matched on age range from 22 to 55 years with a mean age of 38.4 years and mean length of intolerable pain of 5.8 years. Middlesex Hospital Questionnaire (M H Q) was administered to ascertain personality characteristics on six selected variables viz: Anxiety, obsession, phobia, somatization, depression, and hysteria. Mean scores obtained on different variables were analyzed using t-test of significance. Results indicated that the characteristics associated with treated migraine patients were anxiety, obsession, phobia, depression and hysteria whereas the characteristics associated with non-treated migraine patients is somatization. Few studies have investigated the association between different types of headache and personality profiles. The results have not fully clarified the clinical implications and significance of the relationship between headache and psychological characteristics. Huber and Henrich (2003) found in their study that migraine patients had higher neuroticism and introversion scores on the MMPI than the healthy subjects. Cao and coworkers (2002) found that patients with migraine as well as those with episodic and chronic tension type headache showed traits of neuroticism-anxiety and depression, but that no abnormal personality traits were present in migraineurs with aura.


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underlined that the frequency of depression and anxiety disorders in migraineurs is greater than that expected by a chance association. Lipton, Silberstein (1994), and Sheftell, Atlas (2002) reported in their study that mechanisms linking psychiatric disorders to the natural history of migraine remain controversial. Genetic and/or environmental etiologies and psychological vulnerability have been proposed to be implicated in the psychological problems and psychiatric disorders of migraineurs. Depression is a frequent finding, especially in patients with frequent attacks (Breslau, Davis, Schultz and Peterson, 1994). Behavioral and somatic symptoms commonly observed in subjects with chronic headache are also found in patients with anxiety, mood, or somatoform disorders Mongini, Ibertis and Ferla (1994). There are, however, exceptions, at least for some disorders, singly depression, which seems to be more specifically linked to migraine (Breslau, Lipton, Stewart, Schultz and Welch 2003).
Few studies have investigated the association between different types of headache and personality profiles. The results have not fully clarified the clinical implications and significance of the relationship between headache and psychological characteristics. Huber and Henrich (2003) found in their study that migraine patients had higher neuroticism and introversion scores on the MMPI than the healthy subjects. Cao and coworkers (2002) found that patients with migraine as well as those with episodic and chronic tension type headache showed traits of neuroticism-anxiety and depression, but that no abnormal personality traits were present in migraineurs with aura.
International Headache Society classification (2004) was officially available, patients entirely fulfilling the new criteria for chronic migraine might have been included in our study. However, given the well-known difficulties in obtaining satisfactory patient's cooperation, we excluded all the subjects who overused their analgesics. We can therefore reasonably affirm that patients included in our study suffered from chronic migraine according to the new International Headache Society criteria. Moreover, the characteristics of most of our patients seem to fulfill the criteria for chronic migraine without aura as defined by the proposed revision of the International Headache Society classification (Manzoni, Lambru and Torelli, 2006). However, since the study was an observational investigation, we considered it ethical to treat patients with the potentially best therapy. The fact that, in spite of the use of an antidepressant drug, a high score of depression scale remained a predictor of unfavorable prognosis could, at least theoretically, enforce the concept that a personality trait oriented toward depression can negatively influence clinical course of patients with chronic migraine.

MATERIALS AND METHOD
This study was carried out at S.I. Mental and Physical Health Society (SIMPHS), Varanasi, India. The sample consisted of 50 treated and 50 non-treated migraine patient between the age ranges 22 to 55 years with a mean age of 38.4 years. Both the groups were matched on socioeconomic status. All the subjects had experienced for several years and were suffering from chronic migraine pain not less than fifteen times in a month. After dossier completion psychotherapy was provided to each patients for 6 months. This therapy was administered 4 times weekly in first month, 3 times weekly in 2 nd month, 2 times weekly in 3 rd month, once weekly in 4 th months, once in 10 days in 5 th months and once in 2 weeks in 6 th months.

Procedure:
Both groups of subjects were consisted individually by the researcher of this study. After rapport establishment, the Middlesex Hospital Questionnaire was administered to experimental group on the subject one by one at a time. Srivastava, O.N. and Bhatt V.K (1973), developed Middlesex Hospital Questionnaire, B.H.U.Varanasi.

Statistical Analysis:
The data thus obtained were analyzed using Mean, S.D. and't'-test.

RESULTS AND DISCUSSION
With a view to comparing mean scores of treated and non-treated migraine patients on mental health was analyzed using'-test of significance. Results are presented in the following table. Scores obtained by the two groups on anxiety, obsession, phobia, somatization, depression and hysteria were analyzed using 't'-test of significance and results are shown in table. .01 It is obvious from the above table that mean value of treated and non-treated migraine patients do differ significantly on six variables i.e. anxiety, obsession, phobia, somatization, depression and hysteria. The treated group of migraine patients has lower mean value on anxiety, obsession, depression, phobia and hysteria variables and higher on somatization total mental health. This finding reveals that non-treated migraine patients do have significantly higher on anxiety, obsession, phobia, depression, and hysteria and lower on somatization.

CONCLUSION
The present finding of the study has shown on Middlesex Hospital Questionnaire that the characteristics associated with treated migraine patients are anxiety, obsession, depression, phobia and hysteria variables and higher on somatization total mental health.