|Year : 2013 | Volume
| Issue : 2 | Page : 92-97
Impact of socio-demographic factors on quality of life of primary chronic daily headache patients
Supriya Vaish1, Bharat Singh Shekhawat2
1 Department of Psychiatry, Subharti Medical College, Meerut, Uttar Pradesh, India
2 Department of Psychiatry, Government Medical College and M. B. S. Hospital, Kota, Rajasthan, India
|Date of Web Publication||4-Oct-2013|
134, Ram Sadan, Baghpat Road, Meerut, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Primary chronic daily headaches (CDHs) have a considerable negative impact on patients. It leads to poor quality of life (QOL) and diminished ability to function in day-to-day life, in spite of this sufficient work has not been done in this area in India. The purpose of this study was to determine influence of sociodemographic variables on QOL of primary daily headache patients. A prospective study was carried out on 50 consecutive primary CDH patients attending psychiatry and neurology outpatient unit, diagnosed as per IHC 2003 criteria. They were evaluated using a specially designed proforma and QOL was evaluated using the WHOQOL-Brief (Hindi) instrument. Statistical analysis was done on SPSS version 10. Results revealed that old age patients had poor QOL in environmental domain. Female patients had poorer QOL in social relationship and environmental domains. Married patients had poorer QOL in physical, environmental domain, and their total QOL was also poor. There was a significant positive correlation with education status of patients, that is, higher educated patients had better QOL in environmental domain and negative correlation with family size, that is, more the number of family members poorer was the QOL in social relationship domain. Thus, to conclude many sociodemographic factors in the patients suffering from primary CDH have significant negative impact on QOL of patients. Among sociodemographic variables age, gender, marital status, and family size were the important factors that influence QOL of patients.
Keywords: Chronic daily headache, chronic migraine, chronic tension type headache, quality of life
|How to cite this article:|
Vaish S, Shekhawat BS. Impact of socio-demographic factors on quality of life of primary chronic daily headache patients. Indian J Pain 2013;27:92-7
| Introduction|| |
Quality of life (QOL) is a "multidimensional concept which includes overall subjective feeling of wellbeing that is closely related to morale, happiness, and satisfaction Health is cited as one of the most important determinants of QOL. , Originally QOL was evaluated in chronic diseases and in diseases such as cancer and myocardial infarction, which used to negatively influence life expectancy. ,,,,, It is only recently that attention has been focused on the role of QOL in functional pathologies such as primary headaches, which are particularly handicapping and which have a profound impact on general health and one's ability to actively function in society. ,,,,,,,,,
Although headache is not a disease which negatively affects a sufferer's life expectancy, it does constitute a social problem of fairly serious dimensions. The problem results not only in increased economic costs (health care, work absences, and so on), but also in worsening of the patient's QOL, which is at times quite striking.
Chronic daily headache (CDH) is a fairly common and disabling disorder that afflicts individuals across all stages of adulthood. It is a dynamic disorder, marked by relatively high rates of remission and incidence. It is diagnosed when headaches occur more than 4 h/day, 15 headache days per month or more, over a period of three consecutive months. The classification of Silberstein and Lipton distinguishes primary and secondary forms of CDH. The most common long-lasting CDH forms are chronic migraine and chronic tension-type headache. ,,
Health-related QOL of patients with CDH, which although has been given utmost attention in the West, yet developing country such as India, which bears the major burden of CDH has very few studies on the impact of this chronic debilitating illness. Several studies published over the last decade have shown that patients with primary headaches report markedly impaired QOL and decreased ability to function. ,,,,,,,, However, most studies have focused on migraine and very few studies on chronic headache disorders have been published. ,,,,,,
So, we planned this study to evaluate the impact of sociodemographic on QOL of primary CDH patients so as to bring the focus of further research work on this particular field of liaison psychiatry in developing country such as India.
Aims and Objectives
The general objective of the present study was to assess correlation between the sociodemographic profiles of primary CDH patients on their QOL, so as to determine most important factors influencing the QOL.
| Materials and Methods|| |
Fifty consecutive patients of primary CDH diagnosed as per IHC (2003) with duration greater than 4 h/day and frequency of 15 or more days monthly for at least 3 months attending the outpatient department (OPD) of Psychiatry/Neurology, Government Medical College and M.B.S. Hospital, Kota, India, fulfilling the criteria given below were registered after taking consent to participate in the study. A total of 50 healthy matched subjects were recruited as a control group.
- Patients of primary CDHs fulfilling criteria for chronic migraine and chronic tension type headache (IHC, 2003).
- Patients between 18 and 60 years of age.
- Patients of either gender.
Instruments of Study
- Illiterate patients.
- Patient with any comorbid psychiatric disorder.
- Patients with any chronic physical illness, organic brain disorder, substance dependence, or head injury.
- Patients of secondary headaches.
- Patients of mixed headaches.
Transformed score = (actual raw domain score − lowest possible raw domain score) × 100
- A semi-structured self-designed proforma was used for evaluation of sociodemographic variables, including age, gender, marital status, education, employment.
- Quality-of-Life Instrument (WHO QOL - BREF) (Hindi Version) was used, which had 26 items. Each item uses a Likert-type five-point scale where the items are distributed in four domains including (a) physical health and level of independence (seven items assessing areas such as presence of pain and discomfort; dependence on substances or treatments; energy and fatigue; mobility; sleep and rest; activities of daily living; perceived working capacity), (b) psychological wellbeing (eight items assessing areas such as affect, both positive and negative self concept, higher cognitive functions; body image and spirituality), (c) social relationships (three items assessing areas such as social contacts, family support and ability to look after family; sexual activity), and (d) environmental (eight items assessing areas such as freedom; quality of home environment; physical safety and security and financial status; involvement in recreational activity; health and social care: Quality and accessibility). There are also two items that are examined separately: One which asked about the individual's overall perception of QOL and the other which asked about the individual's overall perception of his or her health. ,, The mean score of items within each domain is used to calculate the domain scores compatible with the scores used in WHOQOL-100 and subsequently transformed to a 0-100 scale using the following formula:
The subjects meeting the criteria laid down for the purpose of this study were explained all about the study and proper written consent was taken from patients. They were interviewed immediately after their registration at Psychiatry/Neurology OPD, during the period from April 2009 to June 2009. All information was recorded in a specially designed proforma, which included sociodemographic data and relevant clinical data. Diagnosis of chronic migraine was confirmed by a neurologist. Following this, the patients were administered WHO QOL scale BREF (Hindi) version. Pearson's correlation coefficient was applied and observations were recorded [Table 1], [Table 2], [Table 3] and [Table 4].
| Results|| |
The study included 50 patients who reported primary CDHs. The mean age of patients admitted for the study was 32.68 years. Age ranged from 18 to 49 years with majority (52%) of them falling in the 26-35 years age group. Twenty-eight patients (56%) fulfilled the diagnosis for chronic tension-type headache and 22 patients (44%) for chronic migraine. For the entire sample taken, the female-to-male ratio was 1.22:1; most of the respondents were married (86%), belonged to nuclear families (60%), and were of urban background (58%). Most of the patients had education up to primary level (54%). Forty percent of the patients had monthly family income ranging from 5000 to 15,000 Rs. Thirty-six percent of the sample were homemakers, 40% of them belonged to skilled/unskilled/laborer group. [Table 1], [Table 2] and [Table 3]
In our study, patients with primary CDH had significantly poorer QOL in all the domains, that is, physical health, psychological health, social relationship, environmental, and total QOL as compared with healthy subjects. [Table 4]
| Discussion|| |
Similar findings have been reported previously where functional disability and health-related quality of life (HRQOL) was assessed in Italian patients suffering from primary CDH and it was reported that primary CDH had a strong negative influence on patients' lives, were characterized by marked lower HRQOL than normal people, and also had marked limitations in their ability to function in work and nonwork activities.  Studies have also reported high disability scores when Migraine Disability Assessment (MIDAS) and the Headache Disability Inventory were administered to chronic migraine patients. , Three more studies that employed SF-36 on Spanish, American, and Chinese primary CDH patients reported that CDH have significant influence on most of the domains on HRQOL and also that these patients showed a significant decrease in health-related concept of the SF-36 as compared with healthy subjects. ,
Guitera et al. reported that primary CDH subjects showed a significant decrease in each health-related concept as compared with the healthy subjects. The highest decreases were seen for physical, bodily pain, vitality, and social functioning. 
As shown in the [Table 4], statistically significant correlations between QOL parameters and sociodemographic variables and primary CDH patients were obtained. A negative correlation was found between the age of the patient and environmental QOL, that is, older patients with primary CDH have poor environmental QOL in comparison to younger patients. This finding is similar to findings that have been reported in a study by Wang et al., but some studies did not find any significant correlation between age and primary CDH. ,
Female patients had poorer QOL in social relationship and environmental domains. Married patients had poor QOL in physical health, environmental domain, and total QOL. There was a significant positive correlation with education status of patients, that is, higher educated patients had better QOL in environmental domain and negative correlation with family size, that is, more the number of family members poorer the QOL in social relationship domain. ,
There were no statistically significant correlations between QOL parameters and other sociodemographic variables such as religion, domicile, family type, occupation, and monthly family income.
| Conclusions|| |
Thus, to conclude multiple sociodemographic variables can influence the QOL of the patient of CDH. Future studies on headache should be directed to measure other important parameters, including the clinical variables, treatment variables, and measure their impact on QOL of patient of CDH which is a disorder of great concern. This will guarantee a better therapeutic benefit to the headache sufferers.
Limitations and Directions for Future Research
The results of the current study should be interpreted in the background of following limitations, which may have affected the observations:
- The current study was based exclusively on hospital-based outpatient sample and therefore, may not be the representative sample of patients in community.
- Patient suffering from only chronic migraine and chronic tension-type headache of CDH were taken up for this study. This, however, limits the generalization of results from the present study of patient suffering from other types of CDH.
- The sample size may be regarded as small and hence generalization of our findings to all types of patients is not possible.
- The QOL instrument WHO QOL-BREF used in this study is a generic instrument that was not designed specifically for headache patients, using a combination of both generic and specific instruments would have been a better choice. This instrument only assesses the subjective QOL, whereas the addition to objective measures might have been useful.
- Thus, future studies should be planned and carried out keeping the view in methodological limitations mentioned above.
| Acknowledgment|| |
We are thankful to the Department of Neurology for helping us with study.
| References|| |
|1.||Felce D, Perry J. Quality of life: Its definition and measurement. Res Dev Disabil 1995;16:51-74. |
|2.||"Quality of Life: How good is life for you?". University of Toronto Quality of Life Research Unit. [Last retrieved on 2009 Oct 14]. |
|3.||Lawton MP. Quality of life in chronic illness. Gerontology 1999;45:181-3. |
|4.||Agrawal H, Mourya R, Shrestha RK, Agrawal S. Quality of life among HIV positive individuals in Kathmandu valley and eastern region of Nepal. Kathmandu Univ Med J (KUMJ) 2012;10:3-7. |
|5.||Berlim MT, McGirr A, Fleck MP. Can sociodemographic and clinical variables predict the quality of life of outpatients with major depression? Psychiatry Res 2008;160:364-71. |
|6.||Pettersen KI, Kvan E, Rollag A, Stavem K, Reikvam A. Health-related quality of life after myocardial infarction is associated with level of left ventricular ejection fraction. BMC Cardiovasc Disord 2008;8:28. |
|7.||Ecochard R, Colin C, Rabilloud M, de Gevigney G, Cao D, Ducreux C, et al. Indicators of myocardial dysfunction and quality of life, one year after acute infarction. Eur J Heart Fail 2001;3:561-8. |
|8.||Juenger J, Schellberg D, Kraemer S, Haunstetter A, Zugck C, Herzog W, et al. Health related quality of life in patients with congestive heart failure: Comparison with other chronic diseases and relation to functional variables. Heart 2002;87:235-41. |
|9.||Terwindt GM, Ferrari MD, Tijhuis M, Groenen SM, Picavet HS, Launer LJ. The impact of migraine on quality of life in the general population. The GEM study. Neurology 2000;55:624-9. |
|10.||Cavallini A, Micieli G, Bussone G, Rossi F, Nappi G. Headache and quality of life. Headache 1995;35:29-35. |
|11.||Monzon MJ, Lainez MJ. Quality of life in migraine and chronic daily headache. Cephalalgia 1998;18:638-43. |
|12.||Guitera V, Muñoz P, Castillo J, Pascual J. Quality of life in chronic daily headache: A study in general population. Neurology 2002;58:1062-5. |
|13.||Solomon GD. Evolution of the measurement of quality of life in migraine. Neurology 1997;48:S10-5. |
|14.||Solomon GD, Skobieranda FG, Gregg L. Quality of Life and well-being of headache patients: Measurement by the medical outcomes study instrument. Headache 1993;33:351-8. |
|15.||Michel P, Dartigues JF, Lindoulsi A, Henry P. Loss of productivity and quality of life in migraine sufferers among French workers: Results from the GAZEL cohort. Headache 1997;37:71-8. |
|16.||Simiæ S, Slankamenac P, Kopitoviæ A, Jovin Z, Baniæ-Horvat S. Quality of life research in patients suffering from tension type headache. Med Pregl 2008;61:215-21. |
|17.||Wang SJ, Fuh JL, Lu SR, Juang KD. Quality of life differs among headache diagnoses: Analysis of SF-36 survey in 901 headache patients. Pain 2001;89:285-92. |
|18.||Garza I, Schwedt TJ. Diagnosis and management of chronic daily headache. Semin Neurol 2010;30:154-66. |
|19.||International Headache Society criteria (IHC-2003). |
|20.||Silberstein SD, Lipton RB, Solomon S, Mathew NT. Classification of daily and near-daily headaches: Proposed revisions to the International Headache Society criteria. Headache 1994;34:1-7. |
|21.||Silberstein SD, Lipton RB. Chronic daily headache. Curr Opin Neurol 2000;13:277-83. |
|22.||Simiæ S, Slankamenac P, Cvijanoviæ M, Ilin M, Kopitoviæ A. The impact of headache severity on quality of life of patients with migraine. Med Pregl 2006;59:299-304. |
|23.||Dahlöf CG. Measuring disability and quality of life in migraine. Drugs Today (Barc) 2003;39 Suppl D:17-23. |
|24.||Ruiz de Velasco I, González N, Etxeberria Y, Garcia-Monco JC. Quality of life in migraine patients: A qualitative study. Cephalalgia 2003;23:892-900. |
|25.||Dowson AJ. Assessing the impact of migraine. Curr Med Res Opin 2001;17:298-309. |
|26.||Jensen R. Diagnosis, epidemiology, and impact of tension-type headache. Curr Pain Headache Rep 2003;7:455-9. |
|27.||Holroyd KA, Stensland M, Lipchik GL, Hill KR, O'Donnell FS, Cordingley G. Psychosocial correlates and impact of chronic tension-type headaches. Headache 2000;40:3-16. |
|28.||Lipton RB, Hemelsky SW, Kolodoner KN, Steiner TJ, Stewart WF. Migraine, Quality of life and depression, a population based case-control study. Neurology 2000;55: 629-35. |
|29.||The World Health Organization Quality of Life assessment (WHOQOL): Position paper from the World Health Organization. Soc Sci Med 1995;41:1403-9. |
|30.||Saxena S, Chandiramani K, Bhagava R. WHOQOL-Hindi: A questionnaire for assessing quality of life in health care settings in India. World Health Organization Quality of Life. Natl Med J India 1998;11:160-5. |
|31.||Study protocol for the World Health Organization project to develop a Quality of Life assessment instrument (WHOQOL). Qual Life Res 1993;2:153-9. |
|32.||D'Amico D, Usai S, Grazzi L, Rigamonti A, Solari A, Leone M, et al. Quality of life and disability in primary chronic daily headaches. Neurol Sci 2003;24 Suppl 2:S97-100. |
|33.||Meletiche DM, Lofland JH, Young WB. Quality-of life differences between patients with episodic and transformed migraine. Headache 2001;41:573-8. |
|34.||Magnusson JE, Becker WJ. A comparison of disability and psychological factors in migraine and transformed migraine. Cephalalgia 2002;22:172-8. |
|35.||Monzon MJ, Lainez MJ. Quality of life in migraine and chronic daily headache patients. Cephalalgia 1998;18:638-43. |
|36.||Wang SJ, Fuh JL, Lu SR, Juang KD. Quality of life differs among headache diagnoses: Analysis of SF-36 survey in 901 headache patients. Pain 2001;89:285-92. |
|37.||Rasmussen BK, Jensen R, Schroll M, Olesen J. Epidemiology of headache in a general population - A prevalence study. J Clin Epidemiol 1991;44:1147-57. |
|38.||Rasmussen BK. Migraine and tension-type headache in a general population: Precipitating factors, female hormones, sleep pattern and relation to lifestyle. Pain 1993;53:65-72. |
|39.||Midgette LA, Scher AI. Epidemiology of chronic daily headache. Curr Pain Headache Rep 2009;13:59-63. |
[Table 1], [Table 2], [Table 3], [Table 4]