Analysis Of Triggers,Sleep Quality And Quality-of-life Among Patients With Migraine And Tension-type Headache In A Headache Clinic

Objectives1. To evaluate and explore the triggers of migraine and tension-type headache (TTH) in a headache clinic, and to compare the differences of triggers grouped by headache types, genders and sub-types (migraine with or without aura, episodic or chronic headaches).2. To assess the psychological status and sleep quality in patients with migraine and TTH, to compare the differences grouped by headache types and sub-types and to analysis the related factors on sleep quality of the two types of headaches.3. To evaluate the quality-of-life in patients with migraine and TTH, to compare the differences grouped by headache types and sub-types and to analysis the related factors on the quality-of-life of the two types of headaches.Material and MethodsThe subjects were patients with migraine and TTH visting to International Headache Center, Chinese PLAGeneral Hospital, between April 2013 and March 2014. The diagnoses of headache were based on the criteria of ICHD-3 beta. Research tools were our self-designed questionnaire and 4 scales (PSQI, PHQ-9, GAD-7 and SF-36). The questionnaire contained the information of demographic information, headache characteristics and triggers. SPSS 19.0 statistical software was used to analysis the survey data.Results1. A total of 207 cases of migraine and 120 cases of TTH completed the questionnaire. The common migraine triggers included:mood or stress (63.3%), sleep (79.7%), environmental factors (70.5%), lifestyle (65.2%) and the menstrual cycle (41.9% in women). There was no significantly difference in triggers between groups of migraine (with or without aura). Female migraineurs were more susceptible to be affected by stress or mood (P= 0.048), and males were more susceptible to be influenced by alcohol (P<0.001). Episodic migraineurs (female) were more affected by the menstrual cycle (P<0.001), and chronic migraineurs are more intolerant of hunger (P= 0.029). The common TTH triggers were:mood or stress (60.0%), sleep (65.0%), environmental factors (55.0%) and lifestyle (542%). Compared with men, women patients with TTH were more vulnerable to be caused by environmental factors (P<0.0001) and lifestyle (P=0.0240). Compared with ETTH patients, CTTH were more affected by sleep (P=0.0150), environmental factors (P<.0001) and lifestyle (P =0.0020). The proportion of migraineurs with triggers (95.17%) was higher than that of TTH (83.33%) (P<0.001). Triggers of migraine, such as sleep, environmental change, estrogen change, lifestyle, fasting, and food and drink, were higher than those of TTH significantly. Stress or mood changes showed no significantly difference between the 2 types of headache. The number of triggers in migraineurs is more than that of TTH patients.2. PHQ-9 and GAD-7 mean score were 5.4±5.4 and 4.7±4.9 in 184 cases of migraineurs respectively, and 4.6±5.3 and 5±5.5 in 120 cases of TTH patients. PHQ-9 and GAD-7 mean score was no difference between the two groups. PHQ-9 score in episodic migraine (EM) group was significantly higher than that of ETTH group. PHQ-9 and GAD-7 scores in episodic headache group were significantly lower than those of chronic headache group. Mean PSQI total scores in migraine and TTH group were 7.5±4.7 and 7.4±5.6 respectively. PSQI total scores and factor scores of the 2 groups indicated no significant difference. PSQI total score of EM group was significantly higher than that of episodic TTH group. The comparison of sleep factors item-scores showed that scores of subjective sleep quality, sleep latency, habitual sleep efficiency and daytime dysfunction in EM group were significantly higher than ETTH groups. Comparison results of the number of patients with score greater than 1 showed:the proportion of EM group in habitual sleep efficiency and daytime dysfunction were significantly higher than those of ETTH group. PSQI total score and factor scores in episodic headache group were significantly higher than those of chronic headache group. Results by stepwise regression suggested that:Factors significantly associated with PSQI total score of migraineurs were headache duration and levels of depression and anxiety. Levels of depression and anxiety were the most important aspect. Factors significantly associated with PSQI total score of TTH patients were education, duration of disease, headache frequency, headache duration and level of anxiety. Educational level and levels of anxiety were the main factors.3. A total of 117 cases of migraine and 120 cases of TTH completed the questionnaire and 4 scales. SF-36 scores of migraineurs were significantly lower than Chinese normative values. SF-36 scores of TTH patients were significantly lower than Chinese normative values except for the physical function dimension. TTH group’s physical function score was significantly higher than that of migraine group. ETTH group’s physical function and social function scores were significantly higher than those of EM group. Episodic headache group’s bodily pain, general health, role-emotional and vitality scores were significantly higher than the dimensions of chronic headache group. Factors significantly associated with physical summary score (PSS) of migraineurs were headache duration, frequency and levels of depression. Level of depression was the most affected aspect. Afactor significantly associated with mental summary score (MSS) of migraineurs was the level of depression. Factors significantly associated with PSS score of TTH patients were education, headache frequency, and level of depression.Conclusions1. Most of patients with migraine and TTH have several trigger factors.The number of triggers in migraineurs was more than TTH patients’. The most common headache triggers were mood or stress, environmental factors, sleep and lifestyle. Menstrual cycle, as one of the female migraineurs triggers, was common. Treatment inclined to different triggers would be an important aspect of headache management.2. In the headache clinic, migraine and chronic headache were prone to depression than TTH and episodic headache. Sleep quality in patients with EM was worse than episodic tension-type. Sleep quality in patients with chronic headache was worse than episodic headache. Factors associated with sleep quality of migraine were the degree of anxiety and depression, while those of TTH were education and the degree of anxiety.3. The HRQoL of migraineurs and TTH patients was worse than the level of normal population. EM patients’social and physical function was inferior to ETTH patients. HRQoL in patients with episodic headache was better than chronic headache patients. Headache duration and frequency had some influence on physiological aspects of HRQoL of migraineurs. The degree of depression had some influence onboth physiological and psychological aspects of HRQoL of migraineurs. Education, headache frequency and degree of depression were the main influences on physiological aspects of HRQoL of TTH patients.