Migraine headaches are one of the most frequently occurring nervous system ailments. Approximately 12% of the adult population of the United States and Western Europe suffer from them. They occur more often in women, with approximately 15–18% and 6% of the respective populations being noted as sufferers [
Migraines, similar to other chronic diseases, influence the psychosocial functioning of patients. They limit the sufferer’s abilities both during the onset of pain and between attacks. Acute symptoms limit social relations as well as the capacity to perform professionally and complete household chores [
Quality of life in relation to health (HRQoL) can be seen as referring to an individual’s assessment of their health, functioning (physical and mental), and general well-being [
The aim of this research paper was to investigate the influence of migraine headaches on the everyday functioning of women taking into account sociodemographic and clinical factors.
The research involved 125 female outpatients aged 18–60 with a history of migraine headaches. Headache classification was made in line with the diagnostic criteria specified by the International Headache Society (IHS-2004).
The Migraine Specific Quality of Life questionnaire (MSQ v.2), complied by Glaxo Welcome and made available by the Medical Outcomes Trust, was used as the main diagnostic tool to assess life quality. MSQ v.2 is an improved version of the first MSQ v.1 questionnaire. It assesses the everyday functioning of women over the most recent four-week period of their lives. It consists of 14 items grouped into three subscales [ Role restriction (RR) questions 1–7 determine how the everyday activity of a patient is limited by the disease. Role prevention (RP) questions 8–11 analyze to what extend everyday activities are disrupted by the disease or need to be ceased on its account. Emotional function (EF) questions 12 –14 determine and evaluate the emotional dimension of the disease such as feelings of frustration or helplessness.
The usefulness of the questionnaire was determined by assessing its accuracy and reliability.
Using multivariate analysis it was concluded that the MSQ questionnaire was valid and accurate. Standard deviations remained on the same level indicating that the tested questionnaire did not require data standardization. Individual items correlated the strongest with the domains to which they were assigned. Using Pearson’s
Questionnaire reliability was assessed with the help of two internal consistency measurements intraclass correlation (ICC) and
Intraclass correlation coefficient and
MSQ v.2.1 | ICC |
|
Correlation between positions |
---|---|---|---|
Restrictive function | 0.60 | 0.91 | 0.61 |
Preventive function | 0.62 | 0.87 | 0.63 |
Emotional function | 0.50 | 0.75 | 0.51 |
Total MSQ v2 |
|
|
|
The following tests and procedures were also implemented: Visual Analogue Scale (VAS) (ranging from 0–10 points) to assess pain severity; a questionnaire to gather demographic and clinical data.
For statistical purposes, the VAS was subdivided into three subgroups of pain severity: weak (1–4 pts), moderate (5–7 pts), and severe (8–10 pts).
Demographical data included age, sex, education, professional activity, marital status, and place of residence.
Clinical data included frequency of migraine attacks, headache duration, severity and pain location, prodromes and symptoms accompanying the migraine, pain-relief both pharmacological and nonpharmacological, and comorbidity. Additionally, questions about lifestyle were included, for example, in reference to the use of stimulants such as coffee, strong tea, alcohol, and cigarettes, as well the application of diets and physical activity and exposure to stress.
In order to participate in this research study, patients had to be undergoing treatment at a neurological clinic, suffering from the initial stages of a headache, diagnosed with a migraine as defined by IHS guidelines, aged over 18, consenting to participate in the study.
Statistical analysis was performed with
Having analyzed the statistically significant differences between the MSQ v.2.1 domain and the variables, an attempt was made to assess the effect of migraines on the everyday functioning of women taking into account both clinical and sociodemographic factors.
With this in mind, the data was collated and two categories were created for each variable, for example, headache duration: up to and more than 24 hours, headache frequency: chronic and episodic, and age: below and above 40 years.
As headache frequency was the most differentiating factor out of all the factors, an attempt was made to determine whether there would be a direct influence on the functioning of women when headache frequency was considered together with all other variables like age, headache duration, pain severity, education, or marital status. A similar analysis was conducted taking age into account, together with other variables, with the assumption that it would show a statistically significant differentiation in relation to the functioning of women both under and over 40.
The mean age of the studied group of women was
Differences between MSQ assessment and demographic and clinical variables.
Demographic and clinical factors |
|
MSQ | ||
---|---|---|---|---|
RR mean score | RP mean score | EF mean score | ||
Age | ||||
to 25 | 16 (12.8%) | 53.7 | 61.6 | 62.1a |
25–35 | 49 (39.2%) | 56.8 | 59.3 | 62.4a |
35–45 | 29 (23.2%) | 56.1 | 57.9 | 63.4a |
45–55 | 25 (20.0%) | 52.9 | 51.8 | 51.7a |
over 55 | 6 (4.8%) | 50.0 | 64.1 | 83.3b |
Kruskal-Wallis test ( |
1.95 | 3.33 | 9.49 | |
Significance level | 0.0745 | 0.5045 |
|
|
Education | ||||
Primary | 3 (2.4%) | 52.4a,b | 56.6 | 44.4a |
Vocational | 22 (17.6%) | 64.2b | 58.2 | 63.9b |
High school | 39 (31.2%) | 51.1a | 56.8 | 62.1b |
University | 61 (48.8%) | 54.6a,b | 58.8 | 61.1b |
Kruskal-Wallis test ( |
10.68 | 0.52 | 8.53 | |
Significance level |
|
0.9136 |
|
|
Marital status | ||||
In a relationship | 87 (69.6%) | 55.9 | 59.1 | 60.9 |
Single | 38 (30.4%) | 53.2 | 55.6 | 62.6 |
|
1384.00 | 1096.50 | 5720.50 | |
Significance level | 0.1489 |
|
0.1968 | |
|
||||
Pain frequency | ||||
Chronic |
|
50.7 | 58.3 | 56.1 |
Episodic |
|
58.3 | 69.9 | 65.7 |
|
1276.5 | 1126.0 | 1188.5 | |
Significance level |
|
|
|
|
Pain severity VAS | ||||
1–4 |
|
59.2 | 71.7 | 63.1 |
5–7 |
|
58.9 | 67.3 | 61.6 |
8–10 |
|
50.7 | 62.9 | 64.1 |
Kruskal-Wallis test ( |
13.3 | 6.3 | 6.17 | |
Significance level |
|
|
|
|
Duration | ||||
To 5 hours |
|
55.5 | 60.1 | 62.7 |
Whole day |
|
53.7 | 54.4 | 59.7 |
24–48 hours |
|
56.2 | 57.5 | 60.7 |
Over 48 hours |
|
55.7 | 63.2 | 64.6 |
Kruskal-Wallis test ( |
3.36 | 1.24 | 0.71 | |
Significance level |
|
|
|
Half of the respondents (51.2%) suffered from headaches 1–3 times a month. In the case of 42 women (33.6%) the pain lasted a whole day, for 34 women (27.2%) the pain lasted for 5 hours, and in the case of 19 (15.2%) the pain lasted over 48 hours. For 36 (28.8%) respondents the pain was located in the frontotemporal region. For 60 (48.0%) women the pain was located in one side of the head, whereas 30 (24.0%) experienced pain in the whole of the head. The majority of respondents (49.6%) noted pain at the 5–7 pts level on the linear VAS scale, reflecting moderate severity. Only 30.4% of respondents reported a migraine with aura. The most frequently cited migraine prodromes were sleepiness (20.0%), irritability (36.0%), scotoma (18.4%), numbness in the limbs (8.0%), dizziness (5.6%), and increased appetite (2.4%).
Symptoms connected with the onset of a headache included nausea/vomiting (80.0%), phonophobia (14.0%), photophobia (22.0%), dizziness (6.4%), speech disorders (2.4%), numbness in the body (9.6%), concentration difficulties (10%), and a lowered mood (10%).
In order to alleviate headache pain, all of the respondents used pharmacotherapy but only 10 (8.0%) administered Sumatriptan. Among additional remedies used, the most common were cold compress (34.4%) and sleep (59.2%). Only 10 (8.0%) of the respondents tried massage, acupressure, or herbal tea. Ten (8.0%) women used Divascan or Ergotamine as a preventive remedy.
Out of all the respondents, 23 (18.4%) reported comorbidity. This included diabetes (4.0%), spine/joint degeneration (4.0%), hypertension (4.0%), nephrolithiasis (2.4%), and allergies (2.4%).
Eighty (64.0%) women admitted to using stimulants. Thirty-three (26.4%) smoked cigarettes, 60 (48.0%) drank strong coffee, 46 (36.8%) drank strong tea, and 27 (21.6%) drank alcohol, usually wine or beer, more than twice a month. However, they did not drink more than the equivalent of 50 mL of distilled alcohol. Moderate physical activity was done by 41 (32.8%) women. Ninety (72.0%) respondents reported irregular consumption of meals and 38 (30.4%) ate fatty meals and fast food. The main reasons for the latter were excessive workloads or too many classes at university.
Everyday stress was experienced by 45 (36.0%) of the respondents whilst for 30 (24.0%) women stress was something they experienced a few times a week. Only 7 (5.6%) women admitted to having an absence of stress in their lives.
In order to assess the quality of life, the MSQ v.2.1 questionnaire was used. In each domain the following scores were obtained (mean number of pts ± SD): RR
The quality of life of respondents was analyzed taking into account the influence of headaches on their everyday functioning as well as variables such as age, education, marital status, the frequency of headaches and their duration, and pain severity (Table
Using the Kruskal-Wallis test, statistically significant differences between age and quality of life were only found on the EF (
Statistically significant differences were also observed between education and life quality assessment on the RR (
In reference to marital status, respondents who were single reported higher levels of disruption to everyday functioning (RP
As for the clinical features, headache frequency was most responsible for the greatest significant differences within the life quality assessment (Mann-Whitney: RR
Assessment of life quality versus the severity of pain.
Role restriction
Role prevention
Emotional function
When analyzing the functioning of women in two age groups: below 40 and over 40 (Table
Differences in the MSQ assessment taking into account age and selected demographic and clinical data.
Selected criteria | Age to 40 | Over 40 | |||||
---|---|---|---|---|---|---|---|
RR mean score | RP mean score | EF mean score | RR mean score | RP mean score | EF mean score | ||
Pain severity | |||||||
1–4 |
|
66.3 | 70.0 | 60.0 | 56.2 | 72.5 | 64.4 |
5–7 |
|
57.6 | 66.2 | 61.5 | 63.3 | 71.1 | 61.9 |
8–10 |
|
50.2 | 63.3 | 65.2 | 51.6 | 62.4 | 62.4 |
Kruskal-Wallis test ( |
3.18 | 0.05 | 0.44 | 2.29 | 0.71 | 0.27 | |
Significance level |
|
|
|
|
|
|
|
Frequency | |||||||
Chronic |
|
51.8 | 58.0 | 56.5 | 48.6 | 59.2 | 55.0 |
Episodic |
|
57.6 | 69.3 | 65.8 | 59.3 | 70.9 | 65.7 |
|
588.00 | 474.00 | 503.00 | 131.50 | 138.50 | 143.0 | |
Significance level |
|
|
|
|
|
|
|
Duration | |||||||
To 24 hours | 58.03 | 68.2 | 65.0 | 56.0 | 68.2 | 65.3 | |
Over 24 hours | 51.4 | 60.7 | 58.6 | 57.0 | 67.3 | 59.7 | |
|
487.00 | 591.00 | 613.50 | 247.50 | 224.50 | 230.50 | |
Significance level |
|
|
|
|
|
|
|
Education | |||||||
Primary | 3 (2.4%) | 48.6 | 60.0 | 53.3 | 71.4 | 82.5 | 70.0 |
Vocational | 22 (17.6%) | 60.7 | 63.7 | 57.2 | 59.1 | 66.5 | 55.3 |
High school | 39 (31.2%) | 51.7 | 62.5 | 59.4 | 56.9 | 71.3 | 63.5 |
University | 61 (48.8%) | 56.6 | 67.8 | 66.2 | 52.8 | 63.9 | 65.5 |
Kruskal-Wallis test ( |
2.95 | 1.66 | 3.44 | 1.75 | 1.34 | 1.20 | |
Significance level |
|
|
|
|
|
|
|
Marital status | 70.0 | ||||||
In a relationship | 56.3 | 66.7 | 63.1 | 59.8 | 73.2 | 66.7 | |
Single | 54.6 | 63.5 | 62.0 | 41.1 | 42.5 | 45.0 | |
|
719.00 | 613.00 | 722.50 | 76.00 | 39.00 | 85.00 | |
Significance level |
|
|
|
|
|
|
It was also attempted to assess respondents’ lifestyle. No statistically significant differences in women’s lifestyle were found between those with chronic and episodic headaches.
Migraines are a disease much more commonly found in women than men. In studies investigating large populations, females prevailed among the respondents [
The analysis of mean values from three other MSQ questionnaires conducted by different researchers indicates a medium level of life quality as assessed by their respondents [
In that study 953 patients with migraine headaches were assessed and the following results were obtained: RR-50.8 pts, RP-65.4 pts, and EF-62.9 pts. Additionally, studies conducted in the USA, Canada, and Iran among patients with migraines confirmed that the biggest limitations were felt by respondents on the RR scale, while at the same time it was the lowest scored part of the MSQ v.2 questionnaire [
It was revealed, however, that with the increase in the frequency of headaches there was also an increase in the disruption to the everyday functioning of women aged below 40 as well as an increase in limitations in the women over 40. This trend may stem from the fact that the younger women may have had younger children and were in the process of career building so they were better motivated to perform their domestic and professional duties. This assertion is confirmed by research conducted by Bigal et al. [
Pain is not the only factor negatively influencing everyday functioning. There are also prodromes and symptoms occurring prior and during a headache attack. Martin et al. [
In this paper, the occurrence of depression was not analyzed. However, 10% of women did report a lowered mood, 48% felt tired for most of the day, and 88% felt they had a lowered concentration ability while experiencing a headache. Among other socioeconomic factors influencing the incidence of migraines, authors draw attention to education, financial situation, and the place of residence, though the collected results vary [
The burden of a headache makes patients look for methods to relieve it. Most of the respondents in the study used the treatment designed to stop the migraine pain, most often taking NSAIDs. Triptans were used by less than 10% of the group. Additionally, cold compresses and sleep were applied. In the study by Cevoli et al. [
Only a small group of women apply prophylactic treatment. In this research study, this figure was 8% of the study group, whilst in research conducted by Ertas et al. [
Within this research study, other family members were not included. However, respondents did express feelings of being a burden for others and described frequently experiencing low moods.
On account of headache frequency emerging as the most significant influencing factor, it is of the utmost importance to inform patients of the value of taking prophylactic measures. Central to this is the identification of factors that trigger the onset of migraines. This approach would greatly aid the individual in choosing the appropriate treatment, either pharmacological or others.
The research was not funded by additional resources. It was conducted as a part of the authors’ scientific activities.
The authors declare that there is no conflict of interests regarding the publication of this paper.
Dorota Talarska, Małgorzata Zgorzalewicz-Stachowiak, Michał Michalak, Agrypina Czajkowska, and Karolina Hudaś participated in the study and drafted the paper. All authors read and approved the final paper.