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Objective: The objective of this study was to test the superiority of multidisciplinary approach, that is, Short-Term Psychodynamic Psychotherapy (STPP) plus drug of choice, versus monotherapy, that is, OnabotulinumtoxinA (OnaBoNT-A). Method: We consecutively recorded data from chronic migraine (CM) patients, with or without medication overuse headache (MOH), who underwent STPP or OnaBoNT-A, with a 3-month follow-up schedule. Headache days and analgesics intake were monitored as primary outcome measures. Propensity score matching (PSM) was used to eliminate discrepancies between groups. Discriminant function analysis (DFA) was used to pinpoint predictive factors associated with the clinical response. Results: 96 patients with CM (64% with MOH) were treated with STPP and 54 (59% with MOH) with OnaBoNT-A. At baseline, OnaBoNT-A patients had more failed preventive therapies, more years of illness and chronicity, and were older; STPP patients were more depressed and had a higher HIT-6. Both STPP and OnaBoNT-A patients showed a significant reduction of headache days (STPP: −14 vs. OnaBoNT-A:−14.3) and analgesics intake (STPP: −12,3 vs. OnaBoNT-A −13.5 pills/month), respectively. MOH diminished more in STPP, adherence was higher in OnaBoNT-A. Results were confirmed after PSM balancing of the groups for those variables that resulted as different (but age). Conclusion: OnaBoNT-A monotherapy produced similar results to psychotherapy plus medication, after correcting for baseline differences.

Background Chronic headache (CM) occurs in 2-5% of the general population, often associated with medication-overuse headache (MOH), and comorbid psychiatric disorders [1,2]. Among therapeutic approaches, psychotherapeutic interventions may be effective, either alone or associated with pharmacological therapies. As we previously showed, the short-term psychodynamic psychotherapy (STPP), plus drug therapy, is more effective in patients with probable MOH to reduce headache symptoms and relapse rate than drug therapy alone [3]. Moreover, STPP alone is not inferior to valproate in CM, as preventive therapy [4]. According to psychodinamic diagnosis (BPI) some psychodynamic profiles with poor ability to process the emotional content or low mentalizing level (i.e., pre-psychosis, psychosis and borderline) could be at risk of developing chronic headaches. The aim of the present study was to identify the most frequent psychodynamic profiles in CM and test the effective of STPP in those patients with no record of psychiatric disorders.