Real-world application of Short Term Psychodynamic Psychotherapy (STPP) as chronic migraine preventive therapy: Profiling responders and predictive factors

INTRODUCTION: Among non-pharmacological approach for chronic migraine (CM), Short-Term Psychodynamic Psychotherapy (STPP) is suggested in CM and, particularly, in interrupting medication overuse (MO). In this study, we aim at identifying clinical predictive factors to identify CM patients who could more likely respond to STPP.

METHODS: We designed a prospective real-world observational study on CM patients undergoing STPP. We collected clinical data related to migraine burden (baseline headache days, number of acute medications used, MIDAS, HIT-6), as well as psychiatric comorbidities (though MINI) and mentalization level obtained by the STPP first interview phase (called BPI) to use them as predictive factors by univariate and discriminant function analysis at 3 (early) and 6 months (only sustained response).

RESULTS: We recruited 119 patients (mean age 39.90 ± 14.4, F = 102); 113(94%) completed the STPP treatment. All patients presented a low-to-intermediate mentalization level. After stand-alone STPP, we observed a reduction in monthly headache days and MO at 3 months. Mentalization level didn't affect the STPP outcome (p = 0.40). Early response was directly related to a higher baseline headache days number, the previous used of alternative therapies, and higher Hamilton Depression scale scores. Sustained response was predicted by current use of preventive therapy, pain intensity, HIT-6 score, hypomania, and dysthymia.

CONCLUSION: This real-world study showed that STPP could represent a valid therapeutic option in complex CM patients with a high number of headache days and comorbid depression.