PO-68 | Bipolar disorder spectrum and psychopathology in cluster headache compared to migraine: a cross-sectional study in a hospital headache clinic

Isabella Getuli, Giada Giuliani, Chiara Zilli, Simone Preti, Gaia Chiecchi, Lorenzo Tarsitani, Marta Altieri | Dipartimento di Neuroscienze Umane, Sapienza Università di Roma, Italy

Background: Although numerous studies have been conducted over the last 20 years on the psychological characteristics and psychiatric comorbilities of primary headaches, migraine and tension-type headache, research focused less on cluster headache, a severe and rarer subtype.

Objectives: This study aims to assess psychopathological variables and to investigate the co-occurrence of bipolar disorder spectrum traits in patients with cluster headache disorder as compared with other primary headaches.

Methods: The cross-sectional phase of this observational study is in progress. Adult patients with cluster headache (73) or migraine (283) attending the Headache Outpatient Clinic of the Neurology Service (Department of Human Neuroscience AOU Policlinico Umberto I, Rome) were consecutively enrolled. An ad hoc questionnaire on socio-demographic variables and the following psychometric tools were administered: Headache Impact Test 6 (HIT-6), Mood Disorder Questionnaire (MDQ), Patient Health Questionnaire 9 (PHQ-9), Stress-related Vulnerability Scale 9 (SVS-9), items on alcohol/substance abuse (modified from M.I.N.I), Portrait Values Questionnaire 11 (PVQ-11) and MIDI Personality Trait Scales 30-item. Student t-test and Pearson chi-square test were used to compare the means of the two groups. Moreover, bivariate correlation analyses and multivariate linear regression were performed to identify mood swings predictors.

Results: Among all statistical analysis, the multivariate analysis revealed significant predictors of mood swings (MDQ/PHQ-9 scores). Neuroticism had the strongest effect on both MDQ (p< 0.001, η² =0.087) and PHQ-9 (p<0.001). ScoreSVS (p< 0.001, η²=0.085), ScoreHIT (p=0.001, η²=0.057), Agentivity (p=0.002) and prophylactic therapy (p=0.001) also significantly influenced PHQ-9 scores, while PVQ7-Achievement (p= 0.010) and being part of the cluster headache group (p=0.010) impacted MDQ scores. Contrast analyses showed migraine patients had lower MDQ scores (p= 0.010) but no difference in PHQ-9 scores (p=0.222). Gender and headache-gender interactions were nonsignificant (p> 0.05). Findings highlight neuroticism as a key mental health predictor with headache subtype selectively affecting mood elevation but not mood lowering.

Conclusion: Cluster headache patients exhibit personality traits and motivational values characterized by outward disposition and greater mood lability, suggesting clinicians should screen for (sub)clinical mood disorders—particularly bipolar spectrum features—within this population, as targeted treatment may reduce headache frequency and intensity. Our multivariate analysis further highlights neuroticism as a key predictor of mood disturbances, while headache-specific factors (e.g., SVS/HIT scores) differentially influence depression. These findings imply that mood swings require distinct intervention pathways. Definitive clinical recommendations await validation through larger samples and longitudinal studies, which should also clarify causal relationships between personality traits, mood dysregulation, and headache pathophysiology.