Assessing Patients with Episodic Tension-Type Headache, Migraine or Chronic Daily Headache Using the Short Pain Inventory

Abstract

Background: The Short Pain Inventory (SPI©) is a prospective, validated questionnaire that assesses pain severity and mood disturbances for a variety of conditions. Objectives: In this prospective, within-group, comparative study, the SPI® was used to assess how mood disturbances and coping abilities change over time in patients with tension-type headache, migraine and chronic daily headache attending a primary care headache centre. The healthcare resource utilization of these patients was also assessed retrospectively. Methods: Patients (n = 75) were diagnosed with episodic tension-type headache, migraine or chronic daily headache, and completed a healthcare utilization questionnaire. Patients completed the SPI® ten times over a 7-day period, starting 1 hour after the onset of their next headache. The SPI® data were analysed statistically as Z scores and coping Z scores for the total pain disturbance, total mood disturbance, and individual sub-scores for sedation, social interaction, sadness, anxiety and anger. Data from the healthcare resource utilization questionnaire were analysed as descriptive statistics. Results: All 75 patients completed the healthcare utilization questionnaire and 42 (56.0%) completed the SPI® for the 7-day period. All headache patients showed considerable mood disturbances during a headache. In general, the disturbances were severe in intensity and of the order chronic daily headache > migraine > tension-type headache. The pattern of mood disturbance was different for each type of headache, as was the patients’ ability to cope with the mood changes. Patients with chronic daily headache experienced pain and emotional symptoms, particularly sedation, throughout the 7-day monitoring period. For patients with tension-type headache or migraine, the pain and emotional symptoms resolved within 1–2 days after the headache. The level of healthcare resource utilization was also in the order chronic daily headache > migraine > tension-type headache, similar to the data reported for the SPI®. Conclusions: Patients with headache had significant emotional symptoms associated with their headaches. These symptoms resolved within 1–2 days for patients with episodic tension-type headache or migraine. However, patients with chronic daily headache were profoundly affected, and did not improve physically or emotionally from their headache over a 7-day period. Headache patients generally experienced higher levels of sedation than did patients with other pain conditions we have studied.