Sexual function and distress in postmenopausal women with medication overuse headache (MOH)

Background: Medication overuse headache (MOH) is a chronic and severe head pain with a significant impact on quality of life and psychosocial functioning. Objectives: To assess the rate of sexual function and distress in postmenopausal women hospitalized for treatment of MOH. Methods: A clinical semi-structured interview and validated questionnaires [female sexual function index (FSFI) and female sexual distress scale-revised (FSDS-R)] were administered to 61 postmenopausal women in a stable relationship, suffering from MOH. The State-Trait Anxiety Inventory and the Beck Depression Inventory (BDI) assessed the presence of mood disorders. Results: Mean age of our study sample was 56.7 ± 6.3 years (range 40–77), mean BMI was 24.6 ± 4.2 kg/m2 and 40 women had at least 13 years of education (65.6%). Twenty-one women (34.4%) reported no coital activity in the last 6 months. Female sexual dysfunction [FSD (FSFI cut-off score 26.55)] was diagnosed in 47 women (77%), whereas sexual distress (FSDS-R cut-off 15) was documented in 37 women (60.7%) and hypoactive sexual desire disorder (HSDD) in 29 women (47.5%). Anxiety (69.9%) and depression (75.4%) were present in the majority of the study sample. Interestingly, 26.2% of women with MOH (n¼16) reported menopause at 45 years (either naturally or surgically). Years since menopause (p<0.001) and depression (p<0.02) significantly predicted FSD, whereas menopause at 45 years significantly predicted sexual distress (p<0.001) and HSDD (p<0.006). Even the number of analgesics used per month predicted both sexual distress (p<0.03) and HSDD (p<0.05). Conclusions: This study showed that a high rate of sexual dysfunction and distress is present in postmenopausal women and is part of the headache-related disability. Interestingly, one out of four women with MOH entered menopause prematurely, a finding that deserves further investigation.