title: Factors associated with burden of primary headache in a specialty clinic.
abstract: OBJECTIVE
  To examine factors associated with social, occupational, and psychological burden of common primary headache (migraine and tension-type headache).
  
  
  BACKGROUND
  The personal and social burden of primary headache is high. Health, occupational, social, and psychological factors contributing to burden in people with disabling headache have not been fully unravelled.
  
  
  METHODS
  One hundred eighty consecutive patients with either migraine or tension-type headache attending a specialty headache outpatient clinic for the first time were evaluated over a 9-month period. Headache subtype was operationally defined according to International Headache Society criteria. Headache frequency, duration, and severity were recorded. Occupational and social disability were quantified using the Migraine Disability Assessment questionnaire. Psychological burden was quantified using the 28-item General Health Questionnaire, the Beck Depression Inventory, and the State-Trait Anxiety Inventory. Premorbid vulnerability to life stress was quantified using the neuroticism subscale of the Eysenck Personality Inventory.
  
  
  RESULTS
  Patients with frequent (chronic) headache scored higher on the Migraine Disability Assessment questionnaire and had higher Beck Depression Inventory and General Health Questionnaire depression scores than those with less frequent (episodic) headache. Frequency of headache, but not pain severity, duration, or diagnosis, predicted both Migraine Disability Assessment total disability and General Health Questionnaire/Beck Depression Inventory depression. Neuroticism was predictive of depression but not disability. Patients with chronic migraine had the highest depression and disability scores.
  
  
  CONCLUSIONS
  The number of days per month with headache is a key determinant of headache-related burden in those attending specialty clinics. Frequent (chronic) headache is associated with significantly higher psychopathology scores and general social impairment, but the direction of this relationship is not clear. Those with migraine and chronicity are the most impaired.
authors.affiliation: Migraine/Headache Clinic, Departments of Psychiatry and Neurology, Beaumont Hospital, Dublin, Ireland.
authors.forename: Eugene M
authors.initials: EM
authors.lastname: Cassidy
authors.forename: Esther
authors.initials: E
authors.lastname: Tomkins
authors.forename: Orla
authors.initials: O
authors.lastname: Hardiman
authors.forename: Veronica
authors.initials: V
authors.lastname: O'Keane
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D017281:Cost of Illness; D003863:Depression; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000145:classification / Q000150:complications / Q000523:psychology*; D018710:Pain Clinics; D012008:Recurrence; D018781:Tension-Type Headache / Q000145:classification / Q000150:complications / Q000523:psychology*