Ashina Sait, Buse Dawn C, Bjorner Jakob B, Bendtsen Lars, Lyngberg Ann C, Jensen Rigmor H, Lipton Richard B
BIDMC Comprehensive Headache Center, Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
Scand J Pain. 2021 Jan 25;21(4):778-787. doi: 10.1515/sjpain-2020-0166. Print 2021 Oct 26.
Tension-type headache (TTH) is the most prevalent primary headache disorder. We assessed the cross-sectional impact of TTH on health related quality of life (HRQoL) in a general population. We also examined the association of HRQoL scores with headache frequency, disability, medication overuse, poor self-rated health, psychiatric comorbidity, and pain sensitivity in individuals with TTH.
A sample of 547 subjects completed a headache diagnostic interview, the SF-12 to calculate physical (PCS) and mental (MCS) health component scores, depression (major depression inventory [MDI]) and neuroticism (Eysenck Personality Questionnaire) measures. We defined the following headache diagnosis categories: pure TTH, pure migraine, and coexistent headache (TTH + migraine). Cases were further classified into chronic (≥15) or episodic (<15 headache days/month).
Using generalized linear models (GLM) adjusted for age, sex and education, both PCS-12 and MCS-12 scores varied in groups distinguished by migraine and TTH status; scores were lower for individuals with coexistent headache (TTH + migraine; n=83), followed by pure TTH (n=97) and pure migraine (n=43) compared to the no headache group (n=324) (p≤0.001). In analyses considering chronicity, PCS-12 scores were lower in chronic coexistent headache followed by pure chronic TTH (CTTH), episodic migraine +/- episodic TTH (ETTH) and pure ETTH than in the no headache group (p≤0.001). MCS-12 scores were lower in pure CTTH, followed by chronic coexistent headache, episodic migraine +/- ETTH and pure ETTH compared to the no headache group (p≤0.001). Multiple regression models showed that in TTH, lower PCS-12 scores were associated with age (p=0.04), female sex (p=0.02), and poor self-rated health (p≤0.001). Lower MCS-12 scores in TTH were associated with depression (p≤0.001).
In a population sample, TTH, and to higher degree CTTH, are associated with decreased HRQoL.
紧张型头痛（TTH）是最常见的原发性头痛疾病。我们评估了TTH对普通人群健康相关生活质量（HRQoL）的横断面影响。我们还研究了TTH患者的HRQoL评分与头痛频率、残疾、药物过度使用、自我健康评价差、精神共病及疼痛敏感性之间的关联。
547名受试者完成了头痛诊断访谈、用于计算生理（PCS）和心理（MCS）健康成分得分的SF-12、抑郁（重度抑郁量表[MDI]）及神经质（艾森克人格问卷）测量。我们定义了以下头痛诊断类别：单纯TTH、单纯偏头痛和并存性头痛（TTH + 偏头痛）。病例进一步分为慢性（≥15天/月）或发作性（<15天/月）。
使用针对年龄、性别和教育程度进行调整的广义线性模型（GLM），PCS-12和MCS-12得分在因偏头痛和TTH状态区分的组中有所不同；与无头痛组（n = 324）相比，并存性头痛患者（TTH + 偏头痛；n = 83）、其次是单纯TTH患者（n = 97）和单纯偏头痛患者（n = 43）的得分较低（p≤0.001）。在考虑慢性程度的分析中，慢性并存性头痛、其次是单纯慢性TTH（CTTH）、发作性偏头痛±发作性TTH（ETTH）和单纯ETTH患者的PCS-12得分低于无头痛组（p≤0.001）。与无头痛组相比，单纯CTTH患者的MCS-12得分较低，其次是慢性并存性头痛、发作性偏头痛±ETTH和单纯ETTH患者（p≤0.001）。多元回归模型显示，在TTH患者中，较低的PCS-12得分与年龄（p = 0.04）、女性（p = 0.02）及自我健康评价差（p≤0.001）相关。TTH患者中较低的MCS-12得分与抑郁相关（p≤0.001）。
在一个人群样本中，TTH，尤其是CTTH，与HRQoL降低相关。
