Health-related quality of life in tension-type headache: a population-based study

Sait Ashina; Dawn C Buse; Jakob B Bjorner; Lars Bendtsen; Ann C Lyngberg; Rigmor H Jensen; Richard B Lipton

doi:10.1515/sjpain-2020-0166

Health-related quality of life in tension-type headache: a population-based study

Scand J Pain. 2021 Jan 25;21(4):778-787. doi: 10.1515/sjpain-2020-0166. Print 2021 Oct 26.

Authors

Sait Ashina^{1

2}, Dawn C Buse³, Jakob B Bjorner^{4

5}, Lars Bendtsen⁶, Ann C Lyngberg⁷, Rigmor H Jensen⁶, Richard B Lipton³

Affiliations

¹ BIDMC Comprehensive Headache Center, Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
² Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
³ Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.
⁴ Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark.
⁵ QualityMetric, LLC, Johnston, RI, USA.
⁶ Danish Headache Center, Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark.
⁷ Department of Occupational and Social Medicine, Holbaek Hospital, University of Copenhagen, Holbaek, Denmark.

PMID: 33544560
DOI: 10.1515/sjpain-2020-0166

Abstract

Objectives: Tension-type headache (TTH) is the most prevalent primary headache disorder. We assessed the cross-sectional impact of TTH on health related quality of life (HRQoL) in a general population. We also examined the association of HRQoL scores with headache frequency, disability, medication overuse, poor self-rated health, psychiatric comorbidity, and pain sensitivity in individuals with TTH.

Methods: A sample of 547 subjects completed a headache diagnostic interview, the SF-12 to calculate physical (PCS) and mental (MCS) health component scores, depression (major depression inventory [MDI]) and neuroticism (Eysenck Personality Questionnaire) measures. We defined the following headache diagnosis categories: pure TTH, pure migraine, and coexistent headache (TTH + migraine). Cases were further classified into chronic (≥15) or episodic (<15 headache days/month).

Results: Using generalized linear models (GLM) adjusted for age, sex and education, both PCS-12 and MCS-12 scores varied in groups distinguished by migraine and TTH status; scores were lower for individuals with coexistent headache (TTH + migraine; n=83), followed by pure TTH (n=97) and pure migraine (n=43) compared to the no headache group (n=324) (p≤0.001). In analyses considering chronicity, PCS-12 scores were lower in chronic coexistent headache followed by pure chronic TTH (CTTH), episodic migraine +/- episodic TTH (ETTH) and pure ETTH than in the no headache group (p≤0.001). MCS-12 scores were lower in pure CTTH, followed by chronic coexistent headache, episodic migraine +/- ETTH and pure ETTH compared to the no headache group (p≤0.001). Multiple regression models showed that in TTH, lower PCS-12 scores were associated with age (p=0.04), female sex (p=0.02), and poor self-rated health (p≤0.001). Lower MCS-12 scores in TTH were associated with depression (p≤0.001).

Conclusions: In a population sample, TTH, and to higher degree CTTH, are associated with decreased HRQoL.

Keywords: depression; migraine; pain sensitivity; quality of life; tension-type headache.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Depressive Disorder, Major*
Female
Humans
Migraine Disorders*
Quality of Life
Tension-Type Headache* / epidemiology