Predictive Factors for Disability in Patients with Acute and Chronic Headache

Abstract

Background: Headache is one of the most common types of pain which is considered among the most disabling of diseases. However, the severity of disability in some headache patients is more than others. Objectives: The aim of the present study was to compare different types of headache regarding pain-related variables and psychological factors. We also examined the predicting factors of disability in patients with headache. Methods: This cross-sectional study was performed in 320 patients with various types of headache based on the International Headache Society criteria, which was assessed by neurologists. Data was collected using migraine disability assessment for disability, frequency of headache and for pain intensity, patient health questionnaire for depression, and pain anxiety symptoms scale for pain-related anxiety. ANOVAs and post hoc Tukey’s tests were used for comparing various types of headaches regarding pain-related and psychological factors. Regression analyses assessed the relation of pain-related and psychological variables with disability. Results: Patients with different types of headache revealed no significant differences regarding pain intensity (P = 0.27). Migraine patients showed the most pain frequency and chronicity compared to the other patients (P = 0.000). The levels of disability (P = 0.000), anxiety (P = 0.000) and depressive symptoms (P = 0.000) were also higher in patients with migraine compared to patients suffering from cluster or tension type headache. Pain chronicity (P = 0.01), anxiety (P = 0.007) and depression (P = 0.002) made significant contributions to the explanation of variance in ‘disability’. Conclusions: The findings add further evidence to the relevance of cognitive-behavioral models of pain suggesting an important role for pain-related emotions regarding the consequences of pain (e.g. disability). The current data could help clinicians to decide which factors should be considered for a successful treatment of disability in headache patients.