Predictors of treatment outcome in headache patients with the Millon Clinical Multiaxial Inventory III (MCMI-III)

The objective was to discover possible psychological factors influencing treatment outcome for headache patients referred to psychological treatment in a tertiary headache centre by initial assessment using the Millon Clinical Multiaxial Inventory III (MCMI-III). The MCMI-III was administered to 136 referred patients. Patients with valid protocols who had completed their treatment by October 2003 were included. Multidisciplinary treatment was offered including psychological treatment, mainly pain and stress management, pharmacological treatment and physiotherapy. Medians of MCMI-III scales for patients with and without reduction in headache frequency were compared. All of the eligible 58 patients were included in the study. Patients with reduction in headache frequency after treatment had lower scores on the MCMI-III Somatoform, Major depression and Avoidant personality pattern scales and higher scores on the Alcohol Dependence, Self-Defeating personality pattern, Depressive personality pattern, Drug Dependence, Aggressive personality pattern and Bipolar: Manic scales before treatment compared to patients without effect. Patients with a positive treatment effect reported less symptoms of depression and seemed less inclined to somatisation than non-responders. Responders also appeared more likely to experience increased social or occupational distress and report difficulties with handling emotions and an enduring tendency to focus on negative aspects of the self-image. The results can give valuable information regarding treatment planning and development.