Table 1.
Characteristics of primary studies included in the meta-analysis.
| Study | N (female : male) headache | N (female : male) healthy controls | Headache diagnosis | Questionnaires | Study design | Outcome | Significant findings compared to control(s) | Note |
|---|---|---|---|---|---|---|---|---|
| Aguirre et al., 2000 | 51 CTH (44 : 6) | 50 (NR) | ICHD I edition | MMPI | Cross-sectional study | (i) MMPI profile (ii) Personality predictors of therapeutic response |
(i) Cluster 1 (n = 16): significant elevations on the Hypochondria (p=0.0001), Depression (p=0.03), Paranoia (p=0.007), and Hysteria (p=0.02) Scales (ii) Cluster 2 (n = 33): significant elevations on hypochondria (p=0.0001), depression (p=0.0001), hysteria (p=0.0001), psychopathia (p=0.0001), paranoia (p=0.0001), psychosthenia (p=0.0001), schizophrenia (p=0.0001), mania (p=0.004) and social introversion (p=0.0001) (iii) No differences in therapeutic response between the two clusters |
The clusters did not differ for headache frequency, intensity, or demographic variables |
| Cao et al., 2002 | (i) 72 CTTH (36 : 36) (ii) 33 ETTH (18 : 15) (iii) 15 MA (10 : 5) (iv) 57 MO (36 : 21) |
58 (40 : 18) | ICHD I edition | (i) Zuckerman-Kuhlman's personality questionnaire (ii) Plutchik-van Praag's depression inventory |
Cross-sectional study | (i) Personality and depression in different headache subtypes | (i) Headache groups scored higher than healthy controls on Neuroticism-Anxiety (p < 0.001), Aggression-Hostility (p < 0.01), and PVP Depression Scores (p < 0.001) (ii) CTTH (p < 0.01 and 0.01), ETTH (p < 0.01 and <0.05), and MO (p < 0.01 and <0.05) groups scored higher on neuroticism-anxiety and PVP depression, respectively (iii) MO group (only) scored higher on aggression-hostility than controls (p < 0.01) |
(i) Not significant differences between all headache subtypes but MA |
| Wang et al., 2005 | 41 CTTH (16 : 25) 34 FETTH (13 : 21) 48 MO (39 : 9) |
37 (21 : 16) | ICHD-II edition | Dimensional assessment of personality pathology | Cross-sectional study | (i) Personality disorders in primary headaches | (i) Patients scored significantly higher than HC on submissiveness (p < 0.05), cognitive distortion (p < 0.01), identity problems (p < 0.05), intimacy problems (p < 0.01), social avoidance (p < 0.05), and self-harm (p < 0.001) (ii) Submissiveness was elevated in MIG when compared to FETTH; identity problems were lowered in FETTH but not in either CTH or migraine when compared to controls; social avoidance was lowered in CTTH and migraine, but not in FETTH when compared to controls |
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| Sances et al., 2010 | 82 MOH (62 : 20) 82 EH (63 : 19) |
55 (26 : 29) | ICHD-II edition | MMPI | Cross-sectional study | (i) Personality in MOH | (i) MOH scored higher than EH in the Hypochondriasis (p=0.007) and Health Concerns (p=0.005) Scales; (ii) MOH and EH did not differ in the dependence-related behaviour scales (Addiction potential scale and Addiction Admission Scale); (iii) MOH and EH scored higher than HC in the neurotic scales (hypochondriasis, depression, hysteria) and in other scales such as Paranoia, Psychastenia, and Schizophrenia (iv) MOH and EH scored lower than HC on Ego Strength and Dominance Scales |
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| Galli et al., 2011 | 82 MOH (62 : 20) | 37 (17 : 20) | ICHD-II edition | MMPI-2 | Cross-sectional study | (i) Personality in MOH | MOH scored higher on hypochondriasis, depression (only females), hysteria (only females) (p < 0.0001) | |
| Radat et al., 2013 | 17 MOH (13 : 4) 19 EM (14 : 5) |
17 (13 : 4) | ICHD-II edition | (i) BDI (ii) STAI (iii) PCS (iv) MDQ-H |
Cross-sectional study | (i) Anxiety, depression, catastrophizing, and impulsivity dyscontrol in MOH (ii) Psychological correlates of prognosis in a 1-year follow-up |
(i) MOH scored higher than both EM and HC in MDQ-H and PCS, differing from each other (ii) MOH and EM scored higher than HC in BDI and STAI (iii) No group differences in BIS (iv) Higher PCS scores (p=0.005) predicted risk of relapse |
Small sample size |
| Kayhan, ilik 2016 | 105 CM (53 : 52) | 100 (50 : 50) | ICHD-II edition | (i) SCID-II (ii) MIDAS |
Cross-sectional study | (i) Prevalence of PDs in patients with CM | (i) 85 (81%) were diagnosed with a PD (ii) PDs were more common in the CM group than in the control group (p < 0.0001) (iii) Prevalence of PDs: obsessive-compulsive (50.5%), dependent (19%), avoidant (19%), and passive-aggressive (13.3%) PDs (iv) MIDAS scores of the CM patients with a PD were higher than those of CM patients without a PD (p < 0.0001) |
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| Ashina et al., 2017 | (i) 83 migraine and TTH (ii) 43 pure migraine (iii) 97 pure TTH (NR) |
324 (NR) | ICHD-3 beta | (i) Eysenck personality Questionnaire (ii) Major depression inventory |
Cross-sectional study (general population) | (i) Relationship of neuroticism and depression with type and frequency of headache | (i) Individuals with more frequent headaches and multiple headache types have higher neuroticism and depression vs no headache and episodic headache (p < 0.001) (ii) Migraine: No correlation between days with headache per year and depression or neuroticism. TTH: days with headache were associated with depression but not neuroticism (p < 0.001) |
(i) Poor description of sample characteristics (ii) Most significant findings were related to headache frequency |
| Mose et al., 2019 | 94 MOH (65 : 29) 94 migraine (82 : 12) |
1032 (453 : 579) | ICHD‐III (beta) | (i) NEO‐FFI‐3 (brief version of NEO personality inventory revised) | Cross-sectional study | (i) To investigate personality characteristics by comparing the two clinical groups with a normative sample | (i) Openness, agreeableness, and conscientiousness: migraine scored higher compared to the MOH (p < 0.01) (ii) Neuroticism: MOH had a higher score versus controls (p < 0.01) (iii) Openness and agreeableness: MOH had a lower score compared to controls (p < 0.01) (iv) Conscientiousness: MOH group had a lower score (p < 0.01), whereas migraine had a higher score than controls (p < 0.01) |
Patients with comorbid severe untreated depression, anxiety, PDs, or other pain were excluded |
| Consonni et al., 2020 | 42 CM (39 : 3) | 13 (4 : 9) | ICHD-3 | PCS-I HADS UCLA loneliness scale SF-12 CSQ EUROHIS-QOL-8 item COVID-19 distress questionnaire |
Cross-sectional study | To evaluate the effect of COVID-19 on CM symptoms compared to controls | CM scored higher than controls on pain catastrophizing and CSQ catastrophism (p=0.002) CM scored significantly lower in quality of life (p=0.04) and physical health (p < 0.001) |
Control group = healthy family members; Tests both in the presence/sent by e-mails |
| Cosci et al., 2020 | 100 CM (80 : 20) 100 EM (80 : 20) |
100 (80 : 20) | ICHD‐III (beta) | MIDAS BPI SCID-5 SSI-DCPR-R CID ES PSI MPQ PP |
Cross-sectional study | To explore whether mental pain and PP are more prevalent in CM than EM and HC | CM scored higher than HS on BPI emotional interference (p=0.02) and working interference (p=0.02), MIDAS total (p < 0.001) and MPQ (p < 0.001).CM had higher rates of major depressive episodes (p=0.02), allostatic overload (p=0.004), illness denial (p=0.03), and persistent somatization (p=0.009) and lower rates of health anxiety (p=0.003) and type a behavior (p=0.009) than controls. CM had significantly higher levels of anxiety (p < 0.001), depression (p=0.045) and lower levels of euthymia (p < 0.001) EM scored higher on MIDAS total (p < 0.001) and had higher rates of illness denial (p=0.014) than controls CM scored higher than EM on MIDAS total (p < 0.001), MPQ (p < 0.001) and BPI scales (all p < 0.03), had higher rates of persistent somatization (p < 0.05) and irritable mood (p=02), depression (p=0.002), psychological distress (p < 0.001), and abnormal illness behaviour (p < 0.02) than EM, as well as lower levels of euthymia (p=0.002) |
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| Migliore et al., 2020 | 48 MOH (38 : 10) | 48 HC (37 : 11) | ICHD-3 beta | BDI-2 STAY-Y DERS TAS-20 BIS-11 |
Case-control study | Psychopathological profiles in MOH patients | MOH scored significantly higher than HC on DERS total and subscales (all p < 0.01; except for goal subscale p=ns), TAS-20 total (p=003) and DIF (p < 0.001), BIS-11 attention scale (p=0.006) BDI-2 (p < 0.001) and STAY-Y (p < 0.001) | Subjects reporting medical conditions and neurological or psychiatric diseases were excluded |
| Pistoia et al., 2022 | 65 CM (65 : 0) 65 EM (65 : 0) |
65 HC (65 : 0) | ICHD-3 | PSQI ISI ESS STAI-X2 ASI-3 BDI-II IUI-10 IUS-12 URS IA PCS-I GDMS |
Cross-sectional study | To investigate specific behavioural and psychological factors in migraine To identify a specific mindset associated with migraine |
CM showed greater trait anxiety (p < 0.001) and reported higher pain catastrophizing tendency, feeling of helplessness, and ruminative thinking than HC (all p < 0.001) EM reported more severe pain catastrophizing tendency, feeling of helplessness, and ruminative thinking compared to HC (p=0.013; p=0.007; p=0.009; respectively) CM reported higher sensitivity to anxiety symptoms (p=0.047), pain catastrophizing tendency, feeling of helplessness, and ruminative thinking compared to the EM group (p=0.003; p=0.002; p=0.007; respectively) |
Only female participants Patients with a history of psychiatric comorbidities were excluded |
NR: not reported; M: migraine; CM: chronic migraine; TTH: tension-type headache; EH: episodic headache; EM: episodic migraine; FETTH; frequent episodic tension-type headache; SA: substance addiction; MOH: medication-overuse headache; CTTH: chronic tension-type headache; ETTH: episodic tension-type headache; TCI: temperament and character inventory; BD: blood donors; HGHP: historical group with healthy people; NMCP: no migraine chronic pain; PD: personality disorder; PSE-10: present state examination; BDI: beck depression inventory; SCID-I: structured clinical interview for DSM-IV axis I disorders; SCID-II: structured clinical interview for DSM, personality disorders; STAXI: state-trait anger expression inventory; MIDAS: migraine disability assessment score questionnaire; MMPI-2: Minnesota Multiphasic Personality Inventory-2; ICHD: international classification of headache disorders; DSM-III R: diagnostic and statistical manual of mental disorders, third edition; BPI: brief pain inventory; SSI-DCPR-R is a semistructured interview based on the diagnostic criteria for psychosomatic research–revised; CID: clinical interview for depression; ES: Euthymia Scale; PSI: psycho-social index; MPQ: mental pain questionnaire; PP: pain-proness checklist; HADS: Hospital Anxiety and Depression Scale; SF-12 : 12-item short-form survey; PCS-I: Pain Catastrophizing Scale-I; CSQ: coping strategies questionnaire; EUROHIS-QOL 8-item: EUROHIS-quality of life 8-item index; DERS: Difficulties in Emotion Regulation Scale; TAS-20: Toronto Alexithymia Scale-20 item; BIS: Barratt Impulsiveness Scale; BDI-2: beck depression inventory-2; STAI-Y, state-trait anxiety inventory-Y; PSQI: pittsburgh sleep quality index; ISI: insomnia severity index; ESS: Epworth Sleepiness Scale; STAI-X2: state-trait anxiety inventor-X2; ASI-3: anxiety sensitivity index-3; IUI-10 intolerance of uncertainty inventory-10 item, IUS-12: Intolerance of Uncertainty Scale-12 item; URS: Uncertainty Response Scale; IA: intolerance of ambiguity questionnaire; GDMS: general decision-making style.