LOS ANGELES— Migraine patients with coexisting borderline personality disorder are clinically distinct from the migraine patient population as a whole," according to J. Ivan Lopez, MD. "In particular, they are more severely affected by their headache disorder and more treatment refractory."

An association between headache and borderline personality disorder was previously reported by Saper and Lake, who found that "severe headaches and migraine appear to be more prevalent in patients with borderline personality disorder than the general population." Because the characteristics of migraine in borderline personality disorder have not been thoroughly described, however, Dr. Lopez and colleagues evaluated 50 consecutive patients with migraine and previously documented borderline personality disorder. Dr. Lopez presented the study findings at the 48th Annual Scientific Meeting of the American Headache Society.

There were two comparison groups in the study, each consisting of 50 patients with migraine and no history of borderline personality disorder. One of these groups was matched for age, gender, and headache frequency with the group that had migraine and borderline personality disorder.

Patients in the borderline personality disorder group and the matched control group were treated for their headaches as part of a uniform pharmacologic management plan. The patients with borderline personality disorder also underwent assessment with the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), a tool that Zanarini and associates concluded may be useful for borderline personality disorder screening.

At the end of the six-month study period, the combination of migraine and borderline personality disorder was associated with female gender, more pervasive headache, and more migraine-related disability, reported Dr. Lopez, Associate Professor of Neurology and Pediatric Neurology at the University of South Alabama in Mobile. The patients with migraine and borderline personality disorder were also more likely to develop medication overuse headache, have unscheduled health care visits for acute migraine, and report active depression; they were less likely to respond to drug treatment for headache.

In contrast to the findings of Zanarini et al, the MSI-BPD was not sensitive for borderline personality disorder. Therefore, Dr. Lopez concluded, "Simple screening instruments used to detect borderline personality disorder may be ineffective in the headache clinic setting."

—Timothy Begany

Suggested Reading
Saper JR, Lake AE 3rd. Borderline personality disorder and the chronic headache patient: review and management recommendations. Headache. 2002;42:663-674.
Zanarini MC, Vujanovic AA, Parachini EA, et al. A screening measure for BPD: the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD). J Personal Disord. 2003;17:568-573.

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