Chronic pain and depression in the quality of life of women with migraine--a controlled study

Migraine as an allostatic reset triggered by unresolved interoceptive prediction errors

Until now, a satisfying account of the cause and purpose of migraine has remained elusive. We explain migraine within the frameworks of allostasis (the situationally-flexible, forward-looking equivalent of homeostasis) and active inference (interacting with the environment via internally-generated predictions). Due to its multimodality, and long timescales between cause and effect, allostasis is inherently prone to catastrophic error, which might be impossible to correct once fully manifest, an early indicator which is elevated prediction error (discrepancy between prediction and sensory input) associated with internal sensations (interoception). Errors can usually be resolved in a targeted manner by action (correcting the physiological state) or perception (updating predictions in light of sensory input); persistent errors are amplified broadly and multimodally, to prioritise their resolution (the migraine premonitory phase); finally, if still unresolved, progressive amplification renders further changes to internal or external sensory inputs intolerably intense, enforcing physiological stability, and facilitating accurate allostatic prediction updating. As such, migraine is an effective 'failsafe' for allostasis, however it has potential to become excessively triggered, therefore maladaptive.

Chronic musculoskeletal pain and occupational aspects among Brazilian teachers

Objectives. This study aimed to determine the association between working conditions and chronic musculoskeletal pain (CMP) in regions of the body in teachers. Methods. A cross-sectional study was performed with 958 teachers from Brazil. Outcomes were chronic pain in the upper limbs, lower back and lower limbs. Independent variables were characteristics and perceptions about the work. Poisson regression models were adjusted by socio-demographic, lifestyle and co-morbidity variables. Results. After adjustments, strong associations were observed between a negative perception regarding writing on the board and pain in the upper limbs (prevalence ratio [PR] = 4.65; 95% confidence interval [CI] [2.02, 10.70]) and lower back pain (PR = 2.10; 95% CI [1.06, 4.15]) and between a negative perception of standing duration and pain in the lower limbs (PR = 3.98; 95% CI [1.54, 10.26]). Additionally, the number of workplaces, number of students and conditions for carrying teaching material were associated with pain in the upper limbs. Time in the profession and a negative perception of work-life balance were associated with pain in the lower limbs. Conclusions. Different work conditions were associated with CMP in different body regions. Policies to improve teachers' working conditions, such as providing furniture that meets teachers' ergonomic needs, are needed to reduce CMP.

Assessment of peripheral biomarkers potentially involved in episodic and chronic migraine: a case-control study with a focus on NGF, BDNF, VEGF, and PGE2

Background

Several inflammatory and vascular molecules, and neurotrophins have been suggested to have a possible role in the development of migraine. However, pathophysiological events leading to migraine onset and transformation of episodic migraine (EM) to chronic migraine (CM) are not fully understood. Thus, we aimed to assess peripheral levels of nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and prostaglandin E2 (PGE2) in EM and CM patients, and controls.

Methods

From September 2017 to June 2020, 89 subjects were enrolled in a case-control study; 23 and 36 EM and CM patients, respectively, and 30 age and sex-matched controls. Demographic data and medical history were obtained from all patients. Headache characteristics were recorded at baseline visit and ensuing 30 days for persons with migraine disease. Serum levels of NGF, BDNF, VEGF, and PGE2 were measured once for controls and EM and CM patients, and adjusted for age, sex, and body mass index.

Results

Serum levels of NGF were significantly lower in EM patients compared to controls and CM patients (P-value=0.003 and 0.042, respectively). Serum levels of BDNF were significantly lower in EM and CM patients as opposed to controls (P-value<0.001), but comparable between EM and CM patients (P-value=0.715). Peripheral blood levels of VEGF were significantly higher in EM and CM patients as opposed to controls (P-value<0.001), but not different between EM and CM patients (P-value=0.859). Serum levels of PGE2 were significantly lower in EM patients compared to controls (P-value=0.011), however similar between EM and CM patients (P-value=0.086). In migraine patients, serum levels of NGF and PGE2 positively correlated with headache frequency (NGF: ρ = 0.476 and P-value<0.001; PGE2: ρ = 0.286 and P-value=0.028), while corresponding levels of BDNF and VEGF did not correlate with headache frequency (BDNF: ρ = 0.037 and P-value=0.778; VEGF: ρ= -0.025 and P-value=0.850).

Conclusions

Our findings suggest that NGF, BDNF, PGE2, and VEGF may play a significant role in migraine pathogenesis and/or chronification, and therefore might bear potential value for novel targeted abortive and prophylactic migraine therapy. Further prospective cohort studies with larger sample sizes can more robustly evaluate the implications of these findings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s10194-021-01377-6.

Depression and generalized anxiety symptoms in idiopathic intracranial hypertension: Prevalence, under-reporting and effect on visual outcome

BACKGROUND

Patients with idiopathic intracranial hypertension (IIH) have been reported to have high prevalence of co-existent mood disorders. We investigated the frequency of symptoms of depression and anxiety in a large cohort of patients with IIH without a known psychiatric diagnosis and compared it with the age- and gender-matched control group. We also studied whether the presence and severity of co-existing mood disorder was related to visual outcome in patients with IIH.

METHODS

The Patient Health Questionnaire-8 (PHQ-8) for depression symptoms and the Generalized Anxiety Disorder-7 (GAD-7) questionnaire for symptoms of generalized anxiety were administered via telephone survey to 100 patients with known diagnosis of IIH and 100 control subjects (matched for age and gender) who did not report a history of anxiety or depression during their prior in-person consultations. All participants were also asked whether they had ever been previously diagnosed with a mood disorder during this telephone assessment. Administered questionnaire results were correlated with final visual outcome in IIH cohort.

RESULTS

34 IIH patients and 36 controls self-reported anxiety and/or depression when specifically asked if they had ever been diagnosed with these conditions although this was not reported on clinic intake questionnaires. Mean PHQ-8 depression scale score was 6.5 ± 0.6 in control group and 7.6 ± 0.6 in IIH group (p = 0.18). Mean GAD-7 score was 6.3 ± 0.5 in control group and 7.7 ± 0.6 in the IIH group (p = 0.06). In multivariable regression, scores on both scales were correlated with higher body mass index (BMI), younger age and presence of headache, but not with IIH diagnosis. In the IIH cohort, visual outcomes were not related to GAD-7 or PHQ-8 scores but were predicted by mean deviation on visual fields at presentation.

CONCLUSIONS

Pre-existing diagnosis of anxiety and depression are highly under-reported. Symptoms of anxiety and depression are very common in young women with elevated BMI and headache, however, there was no statistical difference in frequency of these symptoms between IIH and control groups. Presence and severity of mood disorder symptoms did not correlate with the final visual outcome in patients with IIH.

Mental pain and pain-proneness in patients with migraine: results from the PAINMIG cohort-study

BACKGROUND

Pain has been qualified under four categories: nociception, perception of pain, suffering, and pain behaviors. Most of the literature on migraine has devoted attention to the first two. The aim of the present cohort study was to investigate patients with migraine enrolled at a tertiary care unit to study suffering and mental pain and identify potential risk factors for migraine.

METHODS

An observational cross-sectional study was carried out on patients with chronic migraine (CM) and episodic migraine (EM), and healthy subjects (HS). The three groups were matched for age and sex. A comprehensive assessment of migraine disability, pain, psychiatric disorders, psychosomatic syndromes, depressive and anxious symptoms, euthymia, psychosocial variables, mental pain, and pain-proneness (PP) was performed.

RESULTS

Three hundred subjects were enrolled (100 CM, 100 EM, and 100 HS). Based on the multiple regression analyses, those presenting PP (social impairment: odds ratio [OR] = 3.59, 95% confidence interval [CI] = 1.14-11.29; depressive symptoms: OR = 3.82, 95% CI = 1.74-8.41) were more likely to be CM than HS. Those with higher levels of PP (social impairment: OR = 4.04, 95% CI = 1.60-10.22; depressive symptoms: OR = 2.02, 95% CI = 1.26-3.24) were more likely to be EM than HS. Those presenting higher levels of mental pain were more likely to be CM than EM (OR = 1.45, 95% CI = 1.02-2.07).

CONCLUSION

Migraine is an unpleasant sensory and emotional experience associated with psychosocial manifestations that might contribute to the level of suffering of the individuals. Mental pain resulted to be the variable that most differentiated patients with CM from EM.

Humanistic and economic burden of depression and anxiety among adults with migraine: A systematic review

BACKGROUND

Depression and anxiety are well-recognized comorbid health conditions among adults with migraine due to their humanistic and economic burden. This review was conducted to systematically assess the humanistic and economic burden of comorbid depression and/or anxiety disorder among adults with migraine.

METHODS

A systematic literature search was conducted using MEDLINE and CINAHL via EBSCO, EMBASE, and Cochrane Database of Systematic Reviews via OVID. Studies evaluating the humanistic burden and the economic burden of comorbid depression and anxiety among adults with migraine that were published in peer-reviewed English language journals from inception until January 2020 were included.

RESULTS

Out of the 640 identified articles, 23 studies were found eligible and included in this review. Regarding the humanistic burden, health-related quality of life (HRQoL) was examined by 11 studies, 7 studies examined disability, while 2 studies evaluated both HRQoL and disability measures. These studies reported an association between depression and/or anxiety and lower HRQoL and higher disability among adults with migraine. Regarding the economic burden, only three studies were identified and all concluded that depression and/or anxiety are significantly associated with higher healthcare expenditures and utilization among adults with migraine.

CONCLUSIONS

Results of this review highlight the substantial burden of depression and/or anxiety for adults with migraine. Healthcare providers need to identify and treat anxiety and depression for patients living with migraine.

Migraine Disability, Quality of Life, and Its Predictors

Background: Migraine is the most disabling primary headache and is the second most prevalent primary headache affecting middle-aged females more. However, diagnosis and treatment of migraine persists to be inadequate. Despite being a major cause of disability, works done to understand the burden and impact of migraine on daily living remains sparse. Migraine negatively affects one’s sense of well-being in life, and understanding these factors will enable us to better manage the disease.

Objective: To estimate the severity of disability and impairment in quality of life (QOL) secondary to migraine. To enumerate and analyze the factors predicting severity of disability and impairment in QOL secondary to migraine.

Materials and Methods: In this descriptive study, 108 consecutive migraineurs were studied. Headache impact, migraine disability, migraine-specific quality of life (MSQoL), and psychiatric comorbidities were studied using validated questionnaires.

Results: Migraine was seen in 89 females and 19 males with most being in the age group of 20–40 years. Headaches had considerable to relentless impact on the sufferers. Majority of them had a highly significant disability and negatively impacted “MSQoL,”, being affected in all the domains. There was also coexisting anxiety and depression with migraine.

Conclusion: Migraine was more frequently seen in young- and middle-aged females. The longer duration, more frequent migraine attacks, and headache with substantial to severe impact were predictors of both disability and detrimental effects on QOL in migraineurs. Comorbid psychiatric conditions were found to be a significant contributary factor.

Migraine-Specific Quality of Life Questionnaire Chinese version 2.1 (MSQv2.1-C): psychometric evaluation in patients with migraine

BACKGROUND

Migraine ranks as the third most prevalent disease and the seventh most common cause of disability worldwide. To better understand the impact of migraine on the quality of life of individuals with this diagnosis, and how these might differ from one country or culture to another, reliable and valid measures of quality of life that are available in different languages are needed. To address this need, here we (1) translated the Migraine-Specific Quality of Life Questionnaire into Chinese (MSQv2.1-C), and (2) examined the psychometric properties of the measure.

METHODS

Forward and backward translation was conducted using four bilingual experts. One native speaker finalized the translation. Cognitive testing was performed by interviewing 11 monolingual migraineurs, and modifications were made to the MSQv2.1-C, as appropriate. Next, 174 individuals with a history of migraine completed the MSQv2.1-C, along with the SF-12, Migraine Disability Assessment Scale, and numerical rating scale s assessing pain intensity. We then evaluated the reliability and validity of the MSQv2.1-C by performing analyses to evaluate its internal consistency, test-retest reliability, convergent validity, criterion validity, and construct validity.

RESULTS

The MSQv2.1-C scales demonstrated (1) good internal consistency (Cronbach's alpha s ≥ 0.81); (2) good 1-week test-retest reliability (intra-class coefficients ≥0.69 and Spearman's rho correlation coefficients ≥0.74); (3) convergent validity (positive correlations with the MSQ and SF-12 scales [rho range = 0.27 to 0.37, ps < 0.05]); (4) criterion validity (negative correlations [rho range = - 0.51 to - 0.25, ps < 0.05]) between the MSQv2.1-C scales and pain-related criterion variables; and (5) construct validity (item factor loadings ranging from 0.71 to 0.96 [> 0.5]).

CONCLUSIONS

The MSQv2.1-C exhibited satisfactory reliability and validity in a sample of individuals with migraine who speak Chinese. The availability of this measure will facilitate research, including cross-cultural research, on the quality of life of individuals with migraine.

Patients' perspective on the burden of migraine in Europe: a cross-sectional analysis of survey data in France, Germany, Italy, Spain, and the United Kingdom

Background

Migraine is a distinct neurological disease that imposes a significant burden on patients, society, and the healthcare system. This study aimed to characterize the incremental burden of migraine in individuals who suffer from ≥4 monthly headache days (MHDs) by examining health-related quality of life (HRQoL), impairments to work productivity and daily activities, and healthcare resource utilization (HRU) in the EU5 (France, Germany, Italy, Spain, United Kingdom).

Methods

This retrospective cross-sectional study used data from the 2016 National Health and Wellness Survey (NHWS; N = 80,600). Short-Form 36-Item Health Survey, version 2 (SF-36v2) physical and mental component summary scores (PCS and MCS), Short-form-6D (SF-6D), and EuroQoL (EQ-5D), impairments to work productivity and daily activities (Work Productivity and Activity Impairment Questionnaire (WPAI), and HRU were compared between migraine respondents suffering from ≥4 MHDs (n = 218) and non-migraine controls (n = 218) by propensity score matching using sociodemographic characteristics. Chi-square, T-tests, and Mann-Whitney tests were performed to determine significant differences between the groups after propensity score matching.

Results

HRQoL was lower in migraine individuals suffering from ≥4 MHDs compared with non-migraine controls, with reduced SF-36v2 PCS (46.00 vs 50.51) and MCS (37.69 vs 44.82), SF-6D health state utility score (0.62 vs 0.71), and EQ-5D score (0.68 vs 0.81) (for all, p < 0.001). Respondents with migraine suffering from ≥4 MHDs also reported higher levels of absenteeism from work (14.43% vs 9.46%; p = 0.001), presenteeism (35.52% vs 20.97%), overall work impairment (38.70% vs 23.27%), and activity impairment (44.17% vs 27.75%) than non-migraine controls (for all, p < 0.001). Additionally, HRU was significantly higher for individuals with ≥4 MHDs compared to their matched controls. Consistently, migraine subgroups (4–7 MHDs, 8–14 MHDs and CM) had lower HRQoL, greater overall work and activity impairment, and higher HRU compared to non-migraine controls.

Conclusions

Migraine of ≥4 MHDs was associated with poorer HRQoL, greater work productivity loss, and higher HRU compared with non-migraine controls. The findings of the study suggest that an unmet need exists among individuals suffering from ≥4 MHDs in the EU5 suggesting the need for effective prophylactic treatments to lessen the humanistic and economic burden of migraine.

Association Between Migraine and Suicidal Behaviors: A Nationwide Study in the USA

BACKGROUND

Recent studies show migraineurs are at an increased risk of developing suicidal behaviors, even after controlling for comorbid depression. However, previous research has not examined the impact of psychiatric mood disorders on suicidal behaviors in migraineurs within a nationally representative sample.

OBJECTIVE

A cross-sectional study was used to investigate the association between migraine and suicidal behaviors and determine whether psychiatric comorbidities modify this association in a nationwide inpatient cohort.

METHODS

We analyzed the Nationwide Inpatient Sample of hospitalizations compiled from USA billing data. Migraine, suicidal behaviors, and psychiatric disorders were identified based on the International Classification of Diseases, 9^th Revision, Clinical Modification diagnosis codes from hospitalization discharges (2007-2012). Weighted national estimates were used to estimate odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

156,172,826 hospitalizations were included, of which 1.4% had a migraine diagnosis and 1.6% had a diagnosis of suicidal behavior. Migraineurs had a 2.07-fold increased odds of suicidal behaviors (95%CI: 1.96-2.19) compared with non-migraineurs. We repeated analyses after stratifying by depression, anxiety, or posttraumatic stress disorder (PTSD). Among hospitalizations with depression, migraine was associated with a 20% reduced odds of suicidal behaviors (95%CI: 0.76-0.85). Among hospitalizations without depression, migraine was associated with 2.35-fold increased odds of suicidal behaviors (95%CI: 2.20-2.51). In stratified analyses, we noted that among hospitalizations with anxiety, migraineurs had slightly increased odds of suicidal behaviors (OR: 1.07, 95%CI: 1.02-1.13). Among hospitalizations without anxiety, migraine was associated with a 2.06-fold increased odds of suicidal behaviors (95%CI: 1.94-2.20). Similarly, in analyses stratified by PTSD, migraine was not associated with an increased risk of suicidal behaviors (OR: 1.00, 95%CI: 0.94-1.07) among those with PTSD. However, the odds of suicidal behaviors were increased among hospitalizations without PTSD (OR: 1.95, 95%CI: 1.84-2.08).

CONCLUSION

Chronic conditions that do not affect the current hospitalization may not have been reported. The presence of psychiatric diagnoses influences associations of suicidal behaviors with migraine in a national inpatient sample. Migraineurs with diagnosed comorbid psychiatric disorders may be receiving care that mitigates their risk for suicidal behaviors.

Associations Between Depression/Anxiety and Headache Frequency in Migraineurs: A Cross-Sectional Study

BACKGROUND

While migraines have been associated with emotional disturbances, it remains unknown whether the intensity of emotional expression is directly related to migraine frequency.

OBJECTIVE

The present study investigated depression/anxiety among migraineurs.

METHODS

This cross-sectional study included 588 clinical outpatients in Taiwan. Migraines were stratified by attack frequency, with and without auras, and with well-controlled confounding variables. Demographic and clinical data, including sleep characteristics, were collected. Multivariable linear regressions were employed to examine whether migraine frequency (1-4 headache days per month, 5-8 headache days per month, 9-14 headache days per month, or >14 headache days per month) was associated with depression/anxiety symptoms, as indicated by the Beck's Depression Inventory (BDI) and Hospital Anxiety and Depression Subscales (HADS).

RESULTS

BDI total scores were highest in patients with chronic migraines (mean ± SD: 13.2 ± 8.5), followed by those with high frequency (12.1 ± 8.5), medium frequency (10.6 ± 8.0), low frequency (9.1 ± 7.1), and lowest in nonmigraine controls (6.6 ± 5.9), with a significant trend in frequency (P trend < .001); similar results were obtained for HADS scores. BDI and HADS scores were independently related to high-frequency episodic and chronic migraine frequency and to poor sleep quality. The relationship between BDI score and migraine frequency was present in both aura-present (P trend = .001) and aura-absent subgroups (P trend = .029).

CONCLUSION

Higher migraine frequency, either with or without auras, correlated with higher symptom scores of anxiety and depression.

Quality of life in idiopathic intracranial hypertension at diagnosis: IIH Treatment Trial results

OBJECTIVE

The study purpose was to examine vision-specific and overall health-related quality of life (QOL) at baseline in Idiopathic Intracranial Hypertension Treatment Trial patients who were newly diagnosed and had mild visual loss. We also sought to determine the associations between vision-specific QOL scores and visual symptoms, visual function, pain, headache-related disability, and obesity.

METHODS

We assessed QOL using the 36-Item Short Form Health Survey, National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), and 10-Item NEI-VFQ-25 Neuro-Ophthalmic Supplement. We compared these results with those of previously reported idiopathic intracranial hypertension (IIH) QOL studies. We assessed relationships between QOL and other clinical characteristics.

RESULTS

Among 165 participants with IIH (161 women and 4 men with a mean age ± SD of 29.2 ± 7.5 years), vision-specific QOL scores were reduced compared with published values for disease-free controls. Scores of participants were comparable to published results for patients with multiple sclerosis and a history of optic neuritis. A multiple linear regression model for the NEI-VFQ-25 composite score found that perimetric mean deviation in the best eye, visual acuity in the worst eye, visual symptoms, and pain symptoms (headache, neck pain), but not obesity, were independently associated with QOL.

CONCLUSIONS

IIH affects QOL at time of diagnosis even in patients with mild visual impairment. Vision-specific QOL in patients with newly diagnosed IIH may be as decreased as that for patients with other neuro-ophthalmic disorders. IIH treatment should target visual loss and other symptoms of increased intracranial pressure associated with reduced QOL. Reduced QOL does not simply reflect obesity, an underlying IIH risk factor.

Associação de sintomas depressivos e ansiosos com gravidade da migrânea

Objetivo O objetivo do presente estudo foi avaliar a associação do sono, depressão e ansiedade em pacientes com migrânea. Métodos Cinquenta pacientes do sexo feminino, provenientes de um centro terciário de tratamento de cefaleias, com o diagnóstico de migrânea segundo os critérios da International Headache Society, foram incluídas neste estudo. As pacientes foram avaliadas com os seguintes instrumentos: Migraine Disability Assessment test (MIDAS), Headache Impact Test (HIT), Hospital Anxiety (HADS-A) and Depression Scale (HAD-D), Índice de Qualidade do Sono de Pittsburgh (IQSP) e Escala de Sonolência de Epworth (ESE). Resultados As pacientes apresentaram alta prevalência de sintomas de ansiedade (60%) e de depressão (42%), má qualidade do sono (80%) e sonolência diurna (36%). Foi demonstrada correlação positiva entre a gravidade dos sintomas de ansiedade e HIT (p = 0,018; ρ = 0,334), ESE (p = 0,002; ρ = 0,426) e IQSP (p = 0,002; ρ = 0,426). Correlação positiva também foi demonstrada entre a gravidade dos sintomas depressivos e HIT (p < 0,001; ρ = 0,532), ESE (p = 0,035; ρ = 0,299) e IQSP (p = 0,016, ρ = 0,34). Não houve associação entre a qualidade do sono, a sonolência diurna e a gravidade da migrânea. A pontuação na HAD-D foi o principal preditor de impacto grave da migrânea. Conclusão Apesar da alta frequência de distúrbios do sono, o principal fator relacionado ao impacto da migrânea foi a gravidade dos sintomas depressivos.

Quality of life in primary headache disorders: A review

BACKGROUND

Health-related quality of life (HRQoL) is emerging as an important element of clinical research in primary headache disorders, allowing a measure of the impact of headache on patients' well-being and daily life. A better understanding of this may contribute to improved resource allocations and treatment approaches.

OBJECTIVE

The objective of this study is to review available data on HRQoL in primary headache disorders and identify any influencing factors.

METHODS

Database searches including MEDLINE, PsycINFO and EMBASE were performed. Studies that investigated HRQoL in patients with primary headache disorders were included and reviewed. Trials that evaluated the efficacy of medications or interventions were excluded.

RESULTS

A total of 80 articles were included in the review. Both physical and emotional/mental aspects of HRQoL were impaired across headache subtypes, although the extent varied depending on headache type. A number of factors influencing HRQoL were also identified.

CONCLUSION

This narrative review suggests that headache, particularly in its chronic form, has a great impact on HRQoL. Clinical practice should not solely focus on pain alleviation but rather adopt routine assessment of HRQoL. Furthermore, identification and management of associated psychological comorbidities, which can significantly influence HRQoL in headache sufferers, are essential for optimal clinical management.

The role of headache chronicity among predictors contributing to quality of life in patients with migraine: a hospital-based study

BACKGROUND

Headache chronicity has been known to elicit deleterious effects on quality of life (QOL). We evaluated the contribution of headache chronicity to QOL in relation to clinical, psychiatric, and psychosocial variables in patients with migraine.

METHODS

Subjects were recruited from a headache clinic and completed self-report questionnaires including the Migraine Disability Assessment (MIDAS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Migraine-Specific Quality of Life (MSQoL). We obtained predictors of MSQoL by multiple regression analyses. A path analysis model was constructed to analyze interrelationships between the variables.

RESULTS

Among 251 eligible patients, 183 (72.9%) had episodic migraine (EM) and 68 (27.1%) had chronic migraine (CM). Patients with CM had more serious clinical, psychiatric, and poor QOL than did patients with EM. The strongest predictor of the MSQoL score in all patients with migraine was the BDI score (β = -0.373, p < 0.001), followed by the MIDAS score (β = -0.223, p < 0.001), female gender (β = -0.192, p < 0.001), attack duration (β = -0.159, p = 0.001), and headache chronicity (β = -0.130, p = 0.012). Headache chronicity had a direct effect on the MSQoL score and exerted an indirect effect on the MSQoL score through the MIDAS and the BDI scores.

CONCLUSIONS

Chronic migraine appears to impair QOL directly as well as indirectly by provoking disability and depression.

Social impairment of individuals suffering from different types of chronic orofacial pain

Background

The daily life of patients suffering from orofacial pain is considerably impaired as compared to healthy subjects. The aim of this study was to investigate the influence of different categories of orofacial pain on the habitual life of adult individuals.

Methods

Seven hundred eighty-one individuals with orofacial pain were recruited from an initial sample of 1,058 patients. All the individuals were allocated to groups according to their diagnosis: myofascial pain (group A, 676 subjects, 525 females and 151 males; mean age ± SD = 35.2 ± 12.6), migraine (group B, 39 subjects, 29 females and 10 males; mean age ± SD 36.0 ± 10.7), and both myofascial pain and migraine (group C, 66 subjects, 56 females and 10 males, mean age ± SD = 35.6 ± 10.8). Characteristic pain intensity (CPI), disability days (DD), disability score (DS), and graded chronic pain intensity (GCPS) were calculated according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) axis II. Depression and somatization (nonspecific physical symptoms) scores were also calculated.

Results

A significant association between groups and GCPS categories was found (p < 0.0001). Post hoc tests showed a significant difference between groups A and B and between A and C, but not between B and C. In group A, the most frequent GCPS score was grade II. The most frequent GCPS score in groups B and C was grade III, indicating a moderate limiting impairment. This score was more frequent in group B (41%) than in the other groups (group A = 20.6%, group C = 34.8%). GCPS grade IV was more frequent in group C (19.7%) than in the other groups. Group C had significantly higher scores for nonspecific physical symptoms than group A (p < 0.05).

Conclusions

Myofascial pain and migraine sensibly affect the common daily life of adult individuals. The comorbidity of both conditions determines a major impairment.

Assessment of Quality of Life in Migraine

Quality of life is the perception of an individual's position in life associated with his objectives, expectations, interests, and standard's of life. Health-related quality of life, on the other hand, includes satisfaction with his health and emotional reaction to his state of health. Primary headaches are encountered commonly in adults during their most productive years like end of puberty and at the beginning of 50's. Migraine alone is responsible for 1.3% of years with disability in the world, all headaches together being responsible for twice of this load. Headaches both worsen quality of life of individuals and place a significant burden on the society. This review will focus on the effects of primary headaches, especially migraine, on quality of life and tools used to evaluate these effects.

Latin American consensus on guidelines for chronic migraine treatment

Chronic migraine is a condition with significant prevalence all around the world and high socioeconomic impact, and its handling has been challenging neurologists. Developments for understanding its mechanisms and associated conditions, as well as that of new therapies, have been quick and important, a fact which has motivated the Latin American and Brazilian Headache Societies to prepare the present consensus. The treatment of chronic migraine should always be preceded by a careful diagnosis review; the detection of possible worsening factors and associated conditions; the stratification of seriousness/impossibility to treat; and monitoring establishment, with a pain diary. The present consensus deals with pharmacological and nonpharmacological forms of treatment to be used in chronic migraine.