Decision‐making impairment under ambiguity but not under risk may underlie medication overuse in patients with chronic migraine
Objective To explore whether patients with chronic migraine and medication overuse headache (CM + MOH) present with decision‐making deficit. Background Factors underlying MOH in patients with CM remain unclear. Whether the process of decision‐making plays a role in MOH is still controversial. Decisi...
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| Published in | Headache Vol. 63; no. 6; pp. 822 - 833 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | English |
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United States
Wiley Subscription Services, Inc
01.06.2023
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| Abstract | Objective
To explore whether patients with chronic migraine and medication overuse headache (CM + MOH) present with decision‐making deficit.
Background
Factors underlying MOH in patients with CM remain unclear. Whether the process of decision‐making plays a role in MOH is still controversial. Decision‐making varies in the degree of uncertainty: under ambiguity where the probability of outcome is unknown, and under risk where probabilities are known.
Methods
Decisions under ambiguity and risk were assessed with the Iowa Gambling Task and the Cambridge Gambling Task, respectively, whereas executive function was assessed by the Wisconsin Card Sorting Test.
Results
A total of 75 participants: 25 patients with CM + MOH, 25 with CM, and 25 age‐ and sex‐similar healthy controls (HCs), completed this cross‐sectional study. There was no significant difference in headache profiles except for more frequent analgesic use (mean ± SD: 23.5 ± 7.6 vs. 6.8 ± 3.4 days; p < 0.001) and higher Severity of Dependence Scores (median [25th−75th percentile]: 8 [5–11] vs. 1 [0–4]; p < 0.001) in patients with CM + MOH compared to CM. Total net score (mean ± SD) on the Iowa Gambling Task in patients with CM + MOH, CM, and HCs were − 8.1 ± 28.7, 10.9 ± 29.6, and 14.2 ± 28.8, respectively. There was a significant difference between the three groups (F(2, 72) = 4.28, p = 0.017), with patients with CM + MOH making significantly more disadvantageous decisions than patients with CM (p = 0.024) and HCs (p = 0.008), while the CM and HC groups did not differ (p = 0.690). By contrast, there was no significant difference between the groups in the Cambridge Gambling Task and the Wisconsin Card Sorting Test. Furthermore, performance on the Iowa Gambling Task was inversely correlated with analgesic consumption (r = −0.41, p = 0.003), suggesting that decision‐making under ambiguity may be related to MOH.
Conclusions
Our data suggest that patients with CM + MOH had impaired decisions under ambiguous, but not risky situations. This dissociation indicates disrupted emotional feedback processing rather than executive dysfunction, which may underlie the pathogenesis of MOH. |
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| AbstractList | To explore whether patients with chronic migraine and medication overuse headache (CM + MOH) present with decision-making deficit.
Factors underlying MOH in patients with CM remain unclear. Whether the process of decision-making plays a role in MOH is still controversial. Decision-making varies in the degree of uncertainty: under ambiguity where the probability of outcome is unknown, and under risk where probabilities are known.
Decisions under ambiguity and risk were assessed with the Iowa Gambling Task and the Cambridge Gambling Task, respectively, whereas executive function was assessed by the Wisconsin Card Sorting Test.
A total of 75 participants: 25 patients with CM + MOH, 25 with CM, and 25 age- and sex-similar healthy controls (HCs), completed this cross-sectional study. There was no significant difference in headache profiles except for more frequent analgesic use (mean ± SD: 23.5 ± 7.6 vs. 6.8 ± 3.4 days; p < 0.001) and higher Severity of Dependence Scores (median [25th-75th percentile]: 8 [5-11] vs. 1 [0-4]; p < 0.001) in patients with CM + MOH compared to CM. Total net score (mean ± SD) on the Iowa Gambling Task in patients with CM + MOH, CM, and HCs were - 8.1 ± 28.7, 10.9 ± 29.6, and 14.2 ± 28.8, respectively. There was a significant difference between the three groups (F
= 4.28, p = 0.017), with patients with CM + MOH making significantly more disadvantageous decisions than patients with CM (p = 0.024) and HCs (p = 0.008), while the CM and HC groups did not differ (p = 0.690). By contrast, there was no significant difference between the groups in the Cambridge Gambling Task and the Wisconsin Card Sorting Test. Furthermore, performance on the Iowa Gambling Task was inversely correlated with analgesic consumption (r = -0.41, p = 0.003), suggesting that decision-making under ambiguity may be related to MOH.
Our data suggest that patients with CM + MOH had impaired decisions under ambiguous, but not risky situations. This dissociation indicates disrupted emotional feedback processing rather than executive dysfunction, which may underlie the pathogenesis of MOH. Objective To explore whether patients with chronic migraine and medication overuse headache (CM + MOH) present with decision‐making deficit. Background Factors underlying MOH in patients with CM remain unclear. Whether the process of decision‐making plays a role in MOH is still controversial. Decision‐making varies in the degree of uncertainty: under ambiguity where the probability of outcome is unknown, and under risk where probabilities are known. Methods Decisions under ambiguity and risk were assessed with the Iowa Gambling Task and the Cambridge Gambling Task, respectively, whereas executive function was assessed by the Wisconsin Card Sorting Test. Results A total of 75 participants: 25 patients with CM + MOH, 25 with CM, and 25 age‐ and sex‐similar healthy controls (HCs), completed this cross‐sectional study. There was no significant difference in headache profiles except for more frequent analgesic use (mean ± SD: 23.5 ± 7.6 vs. 6.8 ± 3.4 days; p < 0.001) and higher Severity of Dependence Scores (median [25th−75th percentile]: 8 [5–11] vs. 1 [0–4]; p < 0.001) in patients with CM + MOH compared to CM. Total net score (mean ± SD) on the Iowa Gambling Task in patients with CM + MOH, CM, and HCs were − 8.1 ± 28.7, 10.9 ± 29.6, and 14.2 ± 28.8, respectively. There was a significant difference between the three groups (F(2, 72) = 4.28, p = 0.017), with patients with CM + MOH making significantly more disadvantageous decisions than patients with CM (p = 0.024) and HCs (p = 0.008), while the CM and HC groups did not differ (p = 0.690). By contrast, there was no significant difference between the groups in the Cambridge Gambling Task and the Wisconsin Card Sorting Test. Furthermore, performance on the Iowa Gambling Task was inversely correlated with analgesic consumption (r = −0.41, p = 0.003), suggesting that decision‐making under ambiguity may be related to MOH. Conclusions Our data suggest that patients with CM + MOH had impaired decisions under ambiguous, but not risky situations. This dissociation indicates disrupted emotional feedback processing rather than executive dysfunction, which may underlie the pathogenesis of MOH. ObjectiveTo explore whether patients with chronic migraine and medication overuse headache (CM + MOH) present with decision‐making deficit.BackgroundFactors underlying MOH in patients with CM remain unclear. Whether the process of decision‐making plays a role in MOH is still controversial. Decision‐making varies in the degree of uncertainty: under ambiguity where the probability of outcome is unknown, and under risk where probabilities are known.MethodsDecisions under ambiguity and risk were assessed with the Iowa Gambling Task and the Cambridge Gambling Task, respectively, whereas executive function was assessed by the Wisconsin Card Sorting Test.ResultsA total of 75 participants: 25 patients with CM + MOH, 25 with CM, and 25 age‐ and sex‐similar healthy controls (HCs), completed this cross‐sectional study. There was no significant difference in headache profiles except for more frequent analgesic use (mean ± SD: 23.5 ± 7.6 vs. 6.8 ± 3.4 days; p < 0.001) and higher Severity of Dependence Scores (median [25th−75th percentile]: 8 [5–11] vs. 1 [0–4]; p < 0.001) in patients with CM + MOH compared to CM. Total net score (mean ± SD) on the Iowa Gambling Task in patients with CM + MOH, CM, and HCs were − 8.1 ± 28.7, 10.9 ± 29.6, and 14.2 ± 28.8, respectively. There was a significant difference between the three groups (F(2, 72) = 4.28, p = 0.017), with patients with CM + MOH making significantly more disadvantageous decisions than patients with CM (p = 0.024) and HCs (p = 0.008), while the CM and HC groups did not differ (p = 0.690). By contrast, there was no significant difference between the groups in the Cambridge Gambling Task and the Wisconsin Card Sorting Test. Furthermore, performance on the Iowa Gambling Task was inversely correlated with analgesic consumption (r = −0.41, p = 0.003), suggesting that decision‐making under ambiguity may be related to MOH.ConclusionsOur data suggest that patients with CM + MOH had impaired decisions under ambiguous, but not risky situations. This dissociation indicates disrupted emotional feedback processing rather than executive dysfunction, which may underlie the pathogenesis of MOH. To explore whether patients with chronic migraine and medication overuse headache (CM + MOH) present with decision-making deficit.OBJECTIVETo explore whether patients with chronic migraine and medication overuse headache (CM + MOH) present with decision-making deficit.Factors underlying MOH in patients with CM remain unclear. Whether the process of decision-making plays a role in MOH is still controversial. Decision-making varies in the degree of uncertainty: under ambiguity where the probability of outcome is unknown, and under risk where probabilities are known.BACKGROUNDFactors underlying MOH in patients with CM remain unclear. Whether the process of decision-making plays a role in MOH is still controversial. Decision-making varies in the degree of uncertainty: under ambiguity where the probability of outcome is unknown, and under risk where probabilities are known.Decisions under ambiguity and risk were assessed with the Iowa Gambling Task and the Cambridge Gambling Task, respectively, whereas executive function was assessed by the Wisconsin Card Sorting Test.METHODSDecisions under ambiguity and risk were assessed with the Iowa Gambling Task and the Cambridge Gambling Task, respectively, whereas executive function was assessed by the Wisconsin Card Sorting Test.A total of 75 participants: 25 patients with CM + MOH, 25 with CM, and 25 age- and sex-similar healthy controls (HCs), completed this cross-sectional study. There was no significant difference in headache profiles except for more frequent analgesic use (mean ± SD: 23.5 ± 7.6 vs. 6.8 ± 3.4 days; p < 0.001) and higher Severity of Dependence Scores (median [25th-75th percentile]: 8 [5-11] vs. 1 [0-4]; p < 0.001) in patients with CM + MOH compared to CM. Total net score (mean ± SD) on the Iowa Gambling Task in patients with CM + MOH, CM, and HCs were - 8.1 ± 28.7, 10.9 ± 29.6, and 14.2 ± 28.8, respectively. There was a significant difference between the three groups (F(2, 72) = 4.28, p = 0.017), with patients with CM + MOH making significantly more disadvantageous decisions than patients with CM (p = 0.024) and HCs (p = 0.008), while the CM and HC groups did not differ (p = 0.690). By contrast, there was no significant difference between the groups in the Cambridge Gambling Task and the Wisconsin Card Sorting Test. Furthermore, performance on the Iowa Gambling Task was inversely correlated with analgesic consumption (r = -0.41, p = 0.003), suggesting that decision-making under ambiguity may be related to MOH.RESULTSA total of 75 participants: 25 patients with CM + MOH, 25 with CM, and 25 age- and sex-similar healthy controls (HCs), completed this cross-sectional study. There was no significant difference in headache profiles except for more frequent analgesic use (mean ± SD: 23.5 ± 7.6 vs. 6.8 ± 3.4 days; p < 0.001) and higher Severity of Dependence Scores (median [25th-75th percentile]: 8 [5-11] vs. 1 [0-4]; p < 0.001) in patients with CM + MOH compared to CM. Total net score (mean ± SD) on the Iowa Gambling Task in patients with CM + MOH, CM, and HCs were - 8.1 ± 28.7, 10.9 ± 29.6, and 14.2 ± 28.8, respectively. There was a significant difference between the three groups (F(2, 72) = 4.28, p = 0.017), with patients with CM + MOH making significantly more disadvantageous decisions than patients with CM (p = 0.024) and HCs (p = 0.008), while the CM and HC groups did not differ (p = 0.690). By contrast, there was no significant difference between the groups in the Cambridge Gambling Task and the Wisconsin Card Sorting Test. Furthermore, performance on the Iowa Gambling Task was inversely correlated with analgesic consumption (r = -0.41, p = 0.003), suggesting that decision-making under ambiguity may be related to MOH.Our data suggest that patients with CM + MOH had impaired decisions under ambiguous, but not risky situations. This dissociation indicates disrupted emotional feedback processing rather than executive dysfunction, which may underlie the pathogenesis of MOH.CONCLUSIONSOur data suggest that patients with CM + MOH had impaired decisions under ambiguous, but not risky situations. This dissociation indicates disrupted emotional feedback processing rather than executive dysfunction, which may underlie the pathogenesis of MOH. |
| Author | Wang, Han‐Cheng Walsh, Vincent Chen, Wei‐Hung Lau, Chi Ieong |
| Author_xml | – sequence: 1 givenname: Chi Ieong orcidid: 0000-0003-0699-2234 surname: Lau fullname: Lau, Chi Ieong organization: University Hospital – sequence: 2 givenname: Wei‐Hung surname: Chen fullname: Chen, Wei‐Hung organization: Taipei Medical University – sequence: 3 givenname: Han‐Cheng surname: Wang fullname: Wang, Han‐Cheng email: m000737@ms.skh.org.tw organization: National Taiwan University – sequence: 4 givenname: Vincent surname: Walsh fullname: Walsh, Vincent organization: Institute of Cognitive Neuroscience, University College London |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/37232343$$D View this record in MEDLINE/PubMed |
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| Snippet | Objective
To explore whether patients with chronic migraine and medication overuse headache (CM + MOH) present with decision‐making deficit.
Background
Factors... To explore whether patients with chronic migraine and medication overuse headache (CM + MOH) present with decision-making deficit. Factors underlying MOH in... ObjectiveTo explore whether patients with chronic migraine and medication overuse headache (CM + MOH) present with decision‐making deficit.BackgroundFactors... To explore whether patients with chronic migraine and medication overuse headache (CM + MOH) present with decision-making deficit.OBJECTIVETo explore whether... |
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| SubjectTerms | Ambiguity Analgesics Cambridge Gambling Task chronic migraine Decision making Decisions Executive function Gambling Headache Iowa Gambling Task medication overuse headache Migraine Pathogenesis |
| Title | Decision‐making impairment under ambiguity but not under risk may underlie medication overuse in patients with chronic migraine |
| URI | https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fhead.14513 https://www.ncbi.nlm.nih.gov/pubmed/37232343 https://www.proquest.com/docview/2827411003 https://www.proquest.com/docview/2820029082 |
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