Evaluation of risk factors in patients with chronic daily headache and medication overuse headache

Purpose: The aim of this study is to assess and compare the quality of life, daily physical activity level and perception of illness in patients with chronic daily headache, drug overuse headache, episodic migraine and episodic tension-type headache across disease subgroups with respect to possible risk factors such as alcohol/ caffeine/ nicotine use, eating attitude, which may trigger chronic headache and medication overuse. Materials and methods: Patients who applied to Zonguldak Bülent Ecevit University Health Application and Research Center Neurology Outpatient Clinic between January 1, 2020 and December 1, 2020 with a complaint of headache were evaluated with respect to their history and clinical examination in terms of headache subtype. After the initial evaluation, a total of 150 patients diagnosed with episodic migraine, episodic tension-type headache (TTH), chronic daily headache (CDH) and medication overuse headache (MOH) were included in the study. The demographic characteristics of the patients and their caffeine/nicotine/alcohol consumption were recorded in the sociodemographic data form. The pain intensity of the study group was evaluated using the Visual Analogue Scale (VAS), and the physical activity status was evaluated using the International Physical Activity Questionnaire (Short) forms. The SF-36 Quality of Life Scale and the Illness Perception Questionnaire were used to evaluate the quality of life and the condition created by the disease. Anxiety, depression and eating disorders were evaluated with Beck Anxiety Inventory, Beck Depression Inventory, Eating Disorder Examination Questionnaire and Eating Attitude Test. In addition, a face-to-face interview was conducted with the patients by a psychiatrist using the Structured Clinical Interview-Clinical Version for DSM-IV Axis I Disorders (SCID-I) with comorbid psychiatric comorbidity. Results: The study included 81 patients with migraine (27 episodic migraine, 22 chronic migraine, 32 chronic migraine with medication overuse), 69 patients with TTH (24 episodic TTH, 21 chronic TTH, 24 chronic TTH with medication overuse). Of these patients, 119 were female and 31 were male. The mean age of patients with migraine headache was 38.3 ± 11.5, while the mean age of patients with TTH was 46.9 ± 15.0 years. The VAS value, which measures the severity of pain in the migraine group, was found to be significantly higher than that of the TTH group, and the mean duration of pain during the attack was also significantly longer. The mean VAS value was found to be higher in chronic migraine (CDHm) patients when compared to chronic tension-type headache (CDHtth) patients. On the other hand, it was found that the mean pain frequency of patients with CDHtth was more frequent than in patients with CDHm. The mean body mass index was found to be significantly higher in the TTH group than in the migraine patient group. As for the comparison the migraine and TTH groups and the subgroups of these groups; there was no significant difference in terms of daily caffeine consumption, smoking, alcohol consumption and daily physical activity duration. In addition, no difference was found between the Eating Attitude Test and Eating Disorder Examination Questionnaire scores between the groups. When the patients were evaluated according to their Illness Perception Questionnaire scores; disease type mean score and psychological causes mean score were found to be the highest in the CDHtth group among TTH subgroups. Among the subgroups of migraine patients, the mean score of risk-related causes in the Illness Perception Questionnaire was found to be the highest in chronic migraine with medication overuse (MOHm). In addition, the mean score of psychological causes in the Illness Perception Questionnaire was found to be significantly higher in patients with chronic tension-type headache with medication overuse (MOHtth) compared to patients with MOHm. When the subgroups of migraine and TTH patients were examined on the SF-36 scale, only worsening of body pain was significant in CDHm and MOHm subgroups, whereas worsening in physical role difficulty, energy, emotional well-being, body pain, and general health perception was significant in CDHtth and MOHtth subgroups. The mean score of the SF-36 scale physical role difficulty subgroup was found to be lower in MOHtth patients than MOHm patients. Conclusions: In our study, findings supporting the view that psychosocial factors are more effective in the chronicity of the disease and the emergence of medication overuse in the TTH group compared to the migraine group were obtained. The data further points that migraine is a factor in MOH on its own. Lastly, drug overuse in patients with chronic headache may somehow cause a partial decrease in anxiety and depression scores as a result of the anxiolytic effect seen in substance addiction, and may create a partial improvement in the physical, social, financial and psychological effects of chronic headache. Keywords: Addiction, Tension-type headache, Medication overuse headache, Chronic daily headache, Migraine.