Association Between Personality Traits and Onabotulinumtoxin A Response in Patients With Chronic Migraine

Headache. 2020 Jan;60(1):153-161. doi: 10.1111/head.13693. Epub 2019 Nov 6.


Objective: The aim of this study was to analyze the potential association between personality traits and onabotulinumtoxin A (onabotA) response in patients with chronic migraine (CM).

Background: Previous studies from a categorial perspective show that patients with CM have anxious or obsessive personality according to the Salamanca screening test. However, the influence of personality traits in onabotA response in patients with CM has not yet been studied. We hypothesize that cluster C personality traits may be associated with non-response to onabotA.

Methods: This case-control observational study includes patients with CM who received at least 2 treatment cycles of onabotA in 2 headache units between January and May 2018. onabotA response was defined as a reduction of at least 50% in the number of monthly migraine days. Personality traits were evaluated using the Salamanca questionnaire, a validated categorial inventory assessing 11 personality traits.

Results: One hundred and twelve patients, 100/112 (89.6%) females, mean age (standard deviation): 43 (11) years, were recruited. 96/112 (85.7%) achieved response to onabotA. Dependent trait was significantly associated with non-response to onabotA (P = .008; OR: 0.223 [95%CI: 0.074 to 0.675]). Significant association with other personality traits or confounders was not found.

Conclusions: To the best of our knowledge, this is the first study showing personality traits may predict onabotA response in patients with CM. The presence of dependent personality trait in patients with CM is associated with non-response to onabotA.

Keywords: Salamanca questionnaire; chronic migraine; dependent trait; onabotA; personality trait.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Anxiety* / physiopathology
  • Botulinum Toxins, Type A / administration & dosage
  • Botulinum Toxins, Type A / pharmacology*
  • Case-Control Studies
  • Chronic Disease
  • Compulsive Personality Disorder* / physiopathology
  • Dependent Personality Disorder* / physiopathology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Migraine Disorders / drug therapy*
  • Neuromuscular Agents / administration & dosage
  • Neuromuscular Agents / pharmacology*
  • Outcome Assessment, Health Care*
  • Personality Inventory
  • Personality* / physiology


  • Neuromuscular Agents
  • Botulinum Toxins, Type A
  • onabotulinum toxin A