Abstract
BackgroundA better understanding of potential relationship between mood disorders, sleep quality, pain, and headache frequency may assist clinicians in determining optimal therapeutic programs. The aim of the current study was to analyze the effects of sleep quality, anxiety, depression on potential relationships between headache intensity, burden of headache, and headache frequency in chronic tension type headache (CTTH).MethodsOne hundred and ninety-three individuals with CTTH participated. Headache features were collected with a 4-weeks headache diary. The Hospital Anxiety and Depression Scale was used for assessing anxiety and depression. Headache Disability Inventory evaluated the burden of headache. Pain interference was determined with the bodily pain domain (SF-36 questionnaire). Sleep quality was assessed with Pittsburgh Sleep Quality Index. Path analyses with maximum likelihood estimations were conducted to determine the direct and indirect effects of depression, anxiety, and sleep quality on the frequency of headaches.ResultTwo paths were observed: the first with depression and the second with sleep quality as mediators. Direct effects were noted from sleep quality, emotional burden of disease and pain interference on depression, and from depression to headache frequency. The first path showed indirect effects of depression from emotional burden and from sleep quality to headache frequency (first model R2 = 0.12). Direct effects from the second path were from depression and pain interference on sleep quality and from sleep quality on headache frequency. Sleep quality indirectly mediated the effects of depression, emotional burden and pain interference on headache frequency (second model R2 = 0.18).ConclusionsDepression and sleep quality, but not anxiety, mediated the relationship between headache frequency and the emotional burden of disease and pain interference in CTTH.
Highlights
A better understanding of potential relationship between mood disorders, sleep quality, pain, and headache frequency may assist clinicians in determining optimal therapeutic programs
Significant positive correlations were found between the frequency of headaches with headache intensity, headache duration, sleep quality, Headache Disability Inventory (HDI)-E, HDI-P and Hospital Anxiety and Depression Scale (HADS)-D: the greater the headache intensity, the longer the headache duration, the worse the quality of sleep, the higher the emotional or physical component of the headache and the higher the depression, the higher the frequency of headache attacks
The findings from this study show, firstly, and in accordance with prior literature, that depression and sleep quality are factors associated with the frequency of headaches in chronic tension type headache (CTTH) [12, 14]
Summary
A better understanding of potential relationship between mood disorders, sleep quality, pain, and headache frequency may assist clinicians in determining optimal therapeutic programs. The aim of the current study was to analyze the effects of sleep quality, anxiety, depression on potential relationships between headache intensity, burden of headache, and headache frequency in chronic tension type headache (CTTH). In the Global Burden of Disease Study, it was found that tension type headache was the second most prevalent disorder in the world [4]. Current research regarding the pathogenesis of tension type headache is focused on altered nociceptive pain processing and its role on chronification [5]. It appears that among the clinical features of headache, the frequency of attacks is the most relevant outcome since higher frequency of attacks is associated with higher sensitization [6]. Chiu et al reported that poor sleep quality and depression were independently associated with reduced pain thresholds, supporting this assumption [9]
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