Prevalence of Headache Disorders, their Impact on the Daily Lifestyle of the Patients, and the Correlation of their Demographic and Clinical Features with Headache Impact Test 6

Abstract

Introduction: Headache disorders are common among people of all ethnic groups. Primary headache disorders include migraine, tension-type headache, cluster headache, and chronic daily headache syndrome. Secondary headaches include medication overuse headache. The aim of this study is to evaluate the prevalence of various types of headaches disorders, their impact on the daily lifestyle of the patients, and the correlation of their demographic and clinical features with Headache Impact Test 6 (HIT-6). Materials and methods: This prospective study was conducted at a tertiary care hospital in Karachi for a period of six months. 198 patients who came in the outpatient (OPD) department and had a diagnosis of headache were included in this study irrespective of their age and gender. The demographic features, clinical features, and the final diagnoses made by the attending physician using the International Classification of Headache Disorders II (ICHD-II) were recorded. The impact of headaches on the daily lifestyle of the patients was determined by using a six-item HIT-6 questionnaire. For continuous variables, the means and standard deviations were calculated. Whereas for categorical data, frequencies and percentages were calculated. Effect modifiers like demographic and clinical features were controlled through stratification, Fischer’s exact test was used and a p-value of ≤0.05 was taken as significant. Results: The mean age of the patients was 34.39±15.58 years. Age distribution showed 90 (45.45%) patients of eight to 30 years, 84 (42.42%) patients of 31-50 years, and 24 (12.12%) patients of 51-75 years of age. There were 69 (34.8%) male and 129 (65.2%) female patients. The unmarried patients were 81 (40.9%) and married patients were 117 (59.1%). The lower-class patients were 94 (47%), the working-class patients were 87 (43.9%), the middle-class patients were 15 (7.6%), and the upper-class patients were three (1.5%). Primary headache was diagnosed in 150 (75.8%), and the secondary headache was diagnosed in 48 (24.2%) patients. 45 (22.7%) patients had throbbing, 87 (43.9%) had stabbing, and 66 (33.3%) had pressing headache quality. Unilateral headache was in 108 (54.5%), and the bilateral headache was in 90 (45.5%) patients. Pulsatile headache was in 102 (51.5%), and the non-pulsatile headache was in 96 (48.5%) patients. 51 (25.8%) patients had approximately one hour, 42 (21.2%) patients had more than four hours, and 105 (53%) patients had a continuous headache. The frequency was two to three times per week in 51 (25.8%), daily in 81 (40.9%), and variable in 66 (33.3%) patients. The headache occurred in the morning in 39 (19.7%), in the afternoon in 12 (6.1%), in the evening in 24 (12.1%), in the night in 30 (15.2%), and variably in 93 (47%) patients. Headache was mild in 36 (18.2%), moderate in 93 (47%), and severe in 69 (34.8%) patients. Aura, nausea, vomiting, photophobia, phonophobia, runny nose, and lacrimation were also present in many patients. 78 (39.4%) patients had a tension-type headache, and 60 (30,3%) had a migraine while others had several different conditions. The average HIT-6 score was 65.86±7.506. The severe impact was found in 168 (84.8%) patients, substantial impact in nine (4.5%), some impact in 12 (6.1%), and no impact in nine (4.5%) patients. Stratification showed a significant relationship with age, marital status, socioeconomic status, quality of headache, site of headache, pulsatile/non-pulsatile feature, frequency of headache, the severity of headache, and nausea. Conclusions: Tension-type and migraine headaches are the most common headaches that mostly affect young to middle-aged married females of low socioeconomic status. Age, marital status, socioeconomic status, quality of headache, site of headache, pulsatile/non-pulsatile feature, frequency of headache, the severity of headache, and nausea are some of the determinants of the impact of headaches on daily life. Further studies are needed to validate these conclusions.