The Impact of Headache on Quality of Life

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The Impact of Headache on Quality of Life

• Conducted by Gisela M. Terwindt, Michel D.
  Ferrari, and Lenore J. Launer
• Presented by

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Introduction

• Population-based studies have shown that
  migraineurs have reduced HRQoL (Health Related
  Quality of Life) independent of depression.
• HRQoL is reduced with increasing migraine attack
  frequency.
• In both population-based and clinic-based
  studies, CDH (chronic daily headache) patients
  have reduced HRQoL, most marked in subjects with
  analgesic overuse.
• In one population-based study, no difference in
  HRQoL was found between patients with transformed
  migraine (TM) and patients with chronic
  tension-type headache (CTTH).
• The number of the patients in this study was
  relatively small.
• In a clinic-based study, SF-36 scores in patients
  with CDH depended on the percentage of the type
  of patients in the sample the greater the
  proportion of patients with TM, the more impaired
  the SF-36 scores.

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• HRQoL health-related quality of life
• Measurements provide a method to compare the
  burden of different types of headaches
• The impact of the headache can be compared to
  that of other diseases.
• Study short form health survey (SF-36)
• A questionnaire which specifically measures
  physical and social functioning and role
  limitations, mental health, bodily pain,
  vitality, and general health perception.
• A score of 1-100 can be obtained, where 100
  indicates the best functioning
• HRQoL studies can be used to identify treatments
  which optimize outcomes.
• Performed on patients referred to a headache
  clinic
• Selected group of headache patients
• Population based studies also conducted
• Give clearer picture of the effect of headache on
  HRQoL

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Review of Literature

• Guitera, Muñoz, Castillo and Pascual conducted
  the study, Quality of Life in Chronic Daily
  Headache
• Established that lower HRQoL is seen in cases of
  analgesic overuse
• Chronic factor is more impacting than the pain
  intensity
• Lipton is a leading researcher in the area of
  HRQoL in relation to migraines
• He did a population based study in the United
  States and the United Kingdom called Migraine,
  quality of life, and depression.
• He identified depression as comorbid with
  migraines, finding that 47 of the migraineurs in
  the study had depression.
• This study, conducted by Terwindt, Ferrari, and
  Launer has identified the comorbidity of
  muskuloskeletal pain and asthma with migraines.

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• How does a migraine headache impact a patients
  HRQoL in relation to the dimensions defined by
  the questionnaire, SF-36, and how do comorbid
  diseases affect HRQoL?

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Methods

• Subjects
• Dutch-population based study
• 5378 Control group (people not suffering from any
  specified disease)
• 171 People with asthma only
• 1345 People with chronic musculoskeletal pain
  only
• 620 Migraineurs total
• Migraine Patients only
• 111 Migraine w/ aura
• 396 Migraine w/out aura
• 81 Migraine w/ both types
• 30 Both Migraine and Asthma patient
• 239 Both Migraine and Musculoskeletal pain
• Controlled sex, age, socioeconomic class, region
  of residence and marital status

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Methods cont.

• Each subject was given a SF-36 questionnaire with
  36 questions to fill out in order to measure his
  or her perception of health in the previous four
  weeks.
• The responses to each item within a dimension
  were combined to generate a score from 0 to 100.

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Results/Discussion

• In controls versus migraine patients, controls
  had higher HRQoL.
• In the comparison between controls, asthma
  patients, migraine patients, and patients with
  both, HRQoL scores decreased in that order.
• In the next comparison between controls, migraine
  patients, patients with back pain, and patients
  with both, HRQoL scores decreased with both.

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Conclusion

• Migraineurs, regardless of subtype, suffer from
  the compromised HRQoL, especially those with high
  frequency of attacks.
• Migraineurs having a higher prevalence of asthma
  and chronic musculoskletal pain, and decreased
  HRQoL may be partly due to these comorbid
  conditions.