The Ruminative Thought Style with Associated Anxiety Influences the Occurrence of Medication-Overuse Headache

BACKGROUND AND PURPOSE: To determine the relationships between the ruminative thought style, parameters of psychological distress, and the occurrence of medication-overuse headache (MOH). METHODS: The study included 164 subjects: 83 patients (11 males and 72 females) who were first diagnosed as MOH, and 81 healthy subjects (22 males and 59 females) as a control group (CG). The study participants were aged 40.2±11.9 years (mean±standard deviation), and they were assessed using the Ruminative Thought Style Questionnaire and Depression Anxiety Stress Scales. RESULTS: The degree of rumination was higher in patients with MOH than in the CG (p<0.001). Among patients with MOH, females, patients with comorbidities, and those who overuse combined analgesic therapy had a higher degree of rumination (p=0.038, p=0.008, and p=0.015, respectively). In both the MOH patients and CG, the degree of rumination was directly correlated with depression, anxiety, and stress (r=0.473–0.557, p<0.001, for MOH; r=0.303–0.322, p<0.005, for CG). Rumination and anxiety were associated with MOH [odds ratio (OR)=1.123, 95% confidence interval (CI)=1.071–1.178, p<0.001; OR=1.091, 95% CI=1.005–1.185, p=0.039; respectively]. The analysis of the mediation model showed that the link between rumination and MOH is largely direct (86%), and to a lesser extent is additionally influenced by anxiety as a mediator (14%). CONCLUSIONS: A ruminative thought style is associated with MOH both directly and via anxiety. Psychological strategies aimed at decreasing ruminative responses and anxiety could be useful in the prevention of MOH in selected patients.