Chronic Frequent Headache in the General Population: Comorbidity and Quality of Life

Abstract

We studied the nature and extent of comorbidity of chronic frequent headache (CFH) in the general population and the influence of CFH and comorbidity on quality of life. Subjects with CFH (headache on >14 days/month) were identified in a general health survey. We sent a second questionnaire including questions on comorbidity and quality of life to subjects with CFH and subjects with infrequent headache (IH) (1-4 days/month). We recoded comorbidity by using the Cumulative Illness Rating Scale (CIRS) and measured quality of life with the RAND-36, a Dutch version of Short Form-36. CFH subjects (n = 176) had higher comorbidity scores than the IH subjects (n = 141). Mean CIRS scores were 2.94 for CFH and 1.55 for IH [mean difference 1.40, 95% confidence interval (CI) 0.91, 1.89]. The mean number of categories selected was 1.92 in CFH and 1.10 in IH (mean difference 0.82, 95% CI 0.54, 1.11). Fifty percent of CFH subjects had a comorbidity severity level of at least 2, indicating disorders requiring daily medication, compared with 28% of IH subjects (mean difference 22%, 95% CI 12, 33). CFH subjects had more musculoskeletal, gastrointestinal, psychiatric and endocrine/breast pathology than IH subjects. Quality of life in CFH subjects was lower than that of IH subjects in all domains of the RAND-36. Both headache frequency and CIRS score had a negative influence on all domains. We conclude that patients with CFH have more comorbid disorders than patients with infrequent headaches. Many CFH patients have a comorbid chronic condition requiring daily medication. Both high headache frequency and comorbidity contribute to the low quality of life in these patients. ᮀ Chronic daily headache, comorbidity, headache, medication overuse, quality of life

Headache Diagnosis in Primary Care

“…In another family practice study, Weindels et al found that compared to patients with less frequent headache episodes, a group with frequent headaches (≥ 15 days per month) were significantly more likely to have somatic problems, like gastroenterological and musculoskeletal disorders [18], as well as more psychiatric disorders and medication over-use [19]. Both frequent headache and comorbidity were associated with lower quality of life [19].…”

“…Both frequent headache and comorbidity were associated with lower quality of life [19]. Compared to hospital specialists, FPs potentially have more information about patients' other conditions and their management as a whole.…”

To control or not? A motivational perspective on coping with pain

“…Equally, it has been found that patients with MOH, although characterized by a worsening of headache and reduced quality of life 25,26,27 , seem to have equal patterns of disability compared to patients with episodic migraine without overuse. Although medication overuse seems to have its costs, it also seems to enable patients to retain functioning and achieve valuable goals 28 .…”

Psychological, Cognitive and Quality of Life Features in the Elderly with Chronic Headache

“…Van Suijlekom et al [3] found that migraine, tension-type and cervicogenic headache had similar impacts on individuals' quality of life, although the cervicogenic headache group scored lower on physical function-ing, which the authors related to more headache days in this group. Likewise, Wiendels et al [5] also found that those with chronic frequent headache reported a poorer quality of life than those with infrequent headache. Function and well-being are further diminished in headache patients who have other comorbid pain conditions [6,7] .…”

“…While headache could substantially affect well-being [5,21] , its effect on well-being and cognitive factors has not been investigated comprehensively in the elderly population. In addition, chronic headache is often not an isolated pain state but is frequently accompanied by neck pain [22] .…”