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IJCRR - 13(10), May, 2021

Pages: 95-100

Date of Publication: 19-May-2021


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Clinical Characteristics of a Severe Headache and Its Impact on Personal Life of Patients

Author: Reshu Gupta, Prahlad Dhakar, Jitendra Ahuja, Raman Grover

Category: Healthcare

Abstract:Introduction: Headache and its consequent suffering may bring about limitation in daily activities and patients' job performance leading to an economic burden on society. Objective: The study aimed to identify characteristics of a severe headache and its impact on the personal life of patients. Methods: The present study was a cross-sectional hospital-based study conducted at the outpatient department of Medicine at RUHS College of Medical Sciences, Jaipur and associated hospital. It comprised of data collected from 100 patients complaining of headache due to multiple causes and demographic and clinical variables were obtained thereof. A detailed history followed complete physical examination. Patients were asked to fill up and complete a structured questionnaire to obtain the headache characteristics. All analyses were stratified by age and gender. Final diagnoses were made as per criteria laid down by the International Headache Society. Results: Common migraine (28.99%) and vascular headache (28.99%) constituted the majority of cases of the primary headache; with tension headache comprising only 6%. The mean age of the study population was 32.66 \? 14.63 years with an average age of onset being 26.05 \?32 years. Primary headache was found to be more common among married patients (82%) as compared to singles with females outnumbering males. Males were more likely to be fatigued and miss work. Mood changes and appetite loss were more common in females. Conclusion: There is a significant number of serious headache sufferers in Rajasthan who experience a profound social as well as personal impairment as a result of their illness. Further research is recommended to evaluate the extent of interpersonal and personal disability due to this disorder.

Keywords: Common Migraine, Vascular headache, Tension headache, Mood changes

Full Text:

INTRODUCTION

Headache or Cephalalgia is a very common disabling neurological disorder and a major causative factor responsible for public ill-health. Headache and its consequent sufferings represent a tangible personal and social burden worldwide. This highly prevalent disorder is shown to have a significant impact on the patients’ quality of life and job performance leading to a considerable economic burden on society.1,2 However, on account of its episodic nature and the lack of associated mortality, it has not figured highly on the radar of public health initiatives. Nonetheless, frequent and severe headaches have a major impact on the quality of life, of which patients are the best source of information.3 Although most patients receive their treatment in the primary care setting, headache remains a significant component of a neurologist’s practise and domain.

Its prevalence is estimated at 11% - 48% in children6 and 6% -71% in adults.4,5 A higher prevalence has been found in Europe and North America4,6,7 than in Asian and South American countries.8,9 Significant sex differences have been found in multiple epidemiological studies of headache.10

Amongst the primary headaches, tension headache is the most common followed by migraine and cluster headache which is the rarest but most severe type. Out of these primary headaches, migraine has received the most attention from medical researchers, and a large number of studies have examined its correlates. The importance of primary headaches is also emphasized by their global distribution, duration (the majority being life-long conditions) and debilitation that imposes lifestyle restrictions among the large population. 47% population, in general, is estimated to have suffered from any kind of headache at least once within the last year. The recent publication of the Global Burden of Disease survey in 2010 (GBD, 2010) highlights headache as one of the common causes of disability worldwide.11 Other studies reveal tension-type headache and migraine as the second and third most prevalent disorders in the world (after dental caries); Migraine being the seventh highest.12

Headache is an important ailment and one of the leading reasons for outpatient visits to consultants specialized in Neurology and Internal Medicine. Its impact on the disability it imposes is less well documented, so the present study was designed to identify and analyze characteristics of a severe headache and study its impact on the personal lives of patients.

MATERIALS AND METHODS

The present study was a cross-sectional hospital-based study conducted in close association with departments of Internal Medicine, Physiology and Biochemistry at Rajasthan University of Health Sciences College of Medical Sciences and associated group of hospitals after approval from the institutional ethical committee. After obtaining individual informed consent, data from 100 patients attending the outpatient department of Internal Medicine at the associated hospital and complaining of headache due to multiple causes such as meningitis, anaemia, thrombosis, stress, etc. were used to obtain demographic and clinical variables. A physician evaluated the patients with a detailed history followed by a complete physical examination. Each patient was asked to fill up and complete a structured questionnaire to obtain the demographic data and characteristics of their headache. Demographic information in the questionnaire included variables like age, gender, marital status and occupation. The demographic questionnaire was followed by neutral screening questions for headache e.g. “Is this the first attack of the headache of your life?” and “Is this worst headache ever?” etc.). Questions investigating the characteristics of headache like the duration and site of pain, severity, time frame of onset, type of pain, the interval between episodes, aggravating and relieving factors, associated symptoms and possible related conditions were also included in the questionnaire. All analyses were stratified by age and gender. Final diagnoses were made as per the criteria laid down by the International Headache Society (International Classification of Headache Disorders (ICHD)-3 Beta).13

RESULTS

The mean age of the study population (10-75 years) was 32.66 ± 14.63 years. The average age of onset was 26.05 ± 5.32 years. There was no significant difference in mean age between males (32.41 ± 15.86 years) and females (32.92 ± 13.37 years).

Primary headache was found to be more common in married patients (82%) as compared to those who were single; with females outnumbering males (Table 1). The age distribution revealed that the maximum number of cases belonged to the patients between 20 to 30 years followed by a gradual decline, particularly the following menopause in females (Figure 1).

Descriptive analysis of various types of primary headache amongst 20-30 years old patients (n=35) is depicted in Figure 2. The common migraine (n=10, 28.99%) and vascular headache (n=10, 28.99%) constituted the majority of cases of the primary headache, whereas tension headache was the least accounting for only 6%.

An attempt was made to assess the personal impact of 100 cases with five predesigned questions (Table 2). All cases (100%) had complaint of the worst ever headache and the key finding in the majority of individuals (92%) was persistent pain despite measures being taken. It was even observed that the majority of individuals (67%) had complaint of the past headache of a different character. Because of observing the activity of onset of headache, the predominant finding was its appearance while doing a routine activity rather than watching television or working at the office (Table 2).

In the majority of the cases, the headache was gradual in onset (61%), lasting for 1 to 5 days duration (64%) and located diffusely (70%). The typology of pain (squeezing/pressing) was almost the same in the cases which accounted for approximately 45%, but the respondents were only 12% in case of mixed typology. The associated symptoms were widely varied in the respondents except that all (100%) of the individuals had nausea/vomiting or photophobia followed by giddiness and vertigo in 86% of the cases (Table 3).

The respondents (answerable in yes or no) were of varied opinions regarding perception of headache except for sleep and work, which signified that sleep and work were significantly affected (Table 4). The majority of the respondents had perceived mood changes (96%) and fatigue (89%) followed by giddiness (74%) and loss of appetite (71%).  Males were more likely to be fatigued and miss office/work. Mood changes and appetite loss were more common in females. The visual component of sensitivity to bright light and blurred vision was perceived by almost half of the respondents. Visual hallucinations were found in none of them.

DISCUSSION

            Headache has a substantial effect on the patients’ state of wellbeing, quality of life and work-oriented performance leading to personal, professional and socio-economical deficits. Not consistent with the epidemiology of headache, the patients consulting physician in our study were almost the same concerning gender though females outnumbered males very slightly. However, according to a Canadian population-based epidemiological study, Migraine is about thrice as common in females as in males.10 The female to male ratio in our overall referred population was 1.04:1, reflecting the gender-biased prevalence in the general population. A study conducted on dental students in India also reported a higher prevalence in females as compared to males.11-13 Our population of patients was also similar to other clinic-based studies of headache in terms of age and various demographic features.14-18 Sufferers in our study fell into the most productive years of their lives i.e. 20 to 40 years. More than three quarters (82%) of our study population was married with headaches leaving bad repercussions on family relations and activities. Lipton et al. established that the prevalence of migraine varies as a function of age. Migraine is most prevalent between the ages of 25 and 55. Part of the reason the condition has such a big impact in the workplace is that it affects people during their peak productive years.19

            A considerable strength of the study was the use of a common questionnaire on the study population to avoid any bias. The aspects of personal impact identified in Table 4 are worth dwelling on, because they signal effects that are constant and/or cumulative, not merely present during headache episodes. Such consequences are serious impositions on life, particularly the effects on education, career and earnings. 

In a Canadian study, over 70% of referrals accounted for migraineurs and tension-type headaches made up a much smaller proportion (7.9%) of the referrals.10 In contrast to this, migraine was the second most dominant diagnosis in our referred patient population. It was of course likely that a significant proportion of our migraine population had tension-type headaches as well. In a study conducted in North America, Gerth et al. reported that migraineurs are absent from work for almost 17 days each year. Also, sufferers reported only 46% effectiveness while at work with migraine symptoms.19,20 Von Korff et al. reported headache induced decreased work effectiveness, and while working with headache, in the order of 41% for migraine and 24% for other headache types.21 In an American study, Hu et al. estimated huge annual indirect costs incurred by employers because of migraine. Almost 85% indicated a reduced capacity to perform housework or chores.22 Additionally, Matilde Leonardi and Alberto Raggi in their narrative review described the multifactorial aspect of the burden of migraine in everyday life including work-related activities.23

While contemplating the burden of headache, we tried to distinguish between individual and societal burden. The individual burden was determined by symptoms during attacks, by anticipation of symptoms between attacks, and by the reduced quality of life in people suffering from this disorder as compared with the general population. The results showed that family, social, and recreational activities were impacted severely in sufferers of headache. As far as work was concerned, absenteeism and reduced effectiveness was observed in patients especially males. In tune with the above studies, our study also showed a profound debilitating effect of headache on work and family life.

Conclusion

 It can be concluded that there is a significant number of serious headache sufferers in Rajasthan who experience social as well as personal impairment as a result of their illness. Further research is recommended to evaluate the extent of interpersonal and personal disability due to this disorder. Although, the present study posed a limitation that all other headache clinics and tertiary care hospitals in the state did not participate in this study and therefore, our results are not population-based and may be subject to referral bias. In regards to the headache frequency and disability experienced by the patients in our study sample, our study population likely represents the severity of the headache patient pool, comprising of patients who may have posed a treatment challenge to primary care physicians.

Acknowledgement

The authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

Conflict of Interest: None declared

Financial support: None declared

References:

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  12. Martelletti P, Birbeck GL, Katsarava Z, Jensen RH, Stovner LJ, Steiner TJ. The Global Burden of Disease survey 2010, Lifting the Burden and thinking outside the box on headache disorders. J Headache Pain 2013;14:13. 

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Announcements

Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

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SCOPUS indexing: 2014, 2019 to 2021


Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

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This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

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‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


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A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
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A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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