Exploring the impact of comorbid primary headaches and neck pain

Sait Ashina; Richard B. Lipton

doi:10.1016/j.sjpain.2015.03.002

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Exploring the impact of comorbid primary headaches and neck pain

Sait Ashina and Richard B. Lipton

Published/Copyright: July 1, 2015

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From the journal Scandinavian Journal of Pain Volume 8 Issue 1

Migraine, tension-type headache, and neck-pain are highly prevalent in the population and frequently coexist [1,2]. Neck pain is more common in patients with migraine and in patients with tension-type headache in comparison to individuals with no known primary headache disorder [2]. Furthermore, neck pain is more commoninpersons with both migraine and tension-type headache than in individuals with just one of these primary headache disorder [2]. Given that migraine, tension-type headache, and neck pain co-occur, approaches to measuring the impact of headache should take these comorbidities into account. Measures of disease impact, disability and health-related quality of life (HRQoL) measures may be generic or disease specific [3]. Generic measures provide a common yardstick for measuring and comparing the burden of a range of diseases. Disease specific approaches focus on the impact of particular disorders and may be more sensitive to the particular burdensofillness than the generic measures. While there are many generic measures used to assess the impact of pain, and a number of disease specific measures as well, there are no disease specific measures for persons with migraine, tension type headache, and neck pain.

In this issue of the Scandinavian Journal of Pain, Krøll et al. [4] present and validate a new 78-item questionnaire designed to measure the impact of migraine, tension-type headache and neck pain (Impact M-TTH-NP). This report addresses face validity and content validity of their newly developed questionnaire. The Impact M-TTH-NP is based largely on 4-week recall and incorporates measures which target sleep, pain characteristics, stress, headache triggers, physical activity, etc. The Impact M-TTH-NP was validated against existing questionnaires which measure physical activity (International Physical Activity Questionnaire (IPAQ short form), Migraine-Specific Quality of Life Questionnaire (MSQ v. 2.1), WHO-Five Well-Being Index (WHO-5), Major Depression Inventory (MDI) and Neck Disability Index (NDI) in patients with migraine coexistent with tension-type headache and neck pain. Face validity was assessed through interviews of patients with frequent migraine coexistent with tension-type headache and neck pain from major headache. Content validity was assessed by having 13 members of a multidisciplinary team of headache experts review the questions. In addition, item-level content validity index (I-CVI), and the scale-level content validity index average method (S-CVI/Ave) were assessed along with average deviation (AD) index to measure inter-rater agreement. The authors showed that the Impact M-TTH-NP questionnaire had acceptable face validity and excellent content validity with S-CVI/Ave value of 0.92. The authors revised 12 of 78 items in the questionnaire and one during the study. Moreover, 3 existing questionnaires (WHO-5, MDI and NDI) were reported to have acceptable face validity and excellent content validity inthe studied patients.

The new Impact M-TTH-NP questionnaire promises to be a useful tool in evaluating patients with migraine comorbid with tension-type headache and neck pain. Depending upon the intended use several issues remain to be addressed. First, as the validation was performed in a tertiary headache centre and only in female patients with chronic headache (≥15 days with headache per month on average), generalizability to primary care, the general population and to men is uncertain. Second, it would be of interest to know if the questionnaire better captures variability of disease impact in patients with migraine, tension type headache and neck pain relative to a migraine specific questionnaire. Future work should also compare sensitivity to change for the impact M-TTH-NP questionnaire with migraine specific measures in samples with various combinations of the disorders it targets. Finally, psychometric methods could be applied to identify subscales sensitive to specific disorders and to develop short forms which provide both validity and brevity inmeasuring the impact domains of interest.

DOI of refers to article: http://dx.doi.org/10.1016/j.sjpain.2015.03.001.

Department of Neurology, Headache Program, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, 10 Union Square East, Suite 5K, New York, NY 10003, USA. Tel.: +1 212 844 6989; fax: +1 212 844 6962.

Conflict of interest

Conflict of interest statement: Sait Ashina received honoraria for lecturing from Allergan, Nautilus Neurosciences and Neurogesx and served as a consultant for Avanir Pharmaceuticals and Depomed. Richard Lipton received research support from the NIH [PO1 AG03949 (Programme Director), RO1AG025119 (Investigator), RO1AG022374-06A2 (Investigator), RO1AG034119 (Investigator), RO1AG12101 (Investigator), the National Headache Foundation, and the Migraine Research Fund; he serves on the editorial board of Neurology; he has reviewed for the NIA and NINDS; holds stock options in eNeura Therapeutics; and serves as consultant, advisory board member, or has received honoraria from Allergan, American Headache Society, Autonomic Technologies, Boston Scientific, Bristol Myers Squibb, Cognimed, Colucid, Eli Lilly, eNeura Therapeutics, GlaxoSmithK-line, MAP, Merck, Nautilus Neuroscience, Novartis, NuPathe, Pfizer, and Vedanta.

References

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[2] Ashina S, Bendtsen L, Lyngberg AC, Lipton RB, Hajiyeva N, Jensen R. Prevalence of neck pain inmigraine and tension-type headache: a population study. Cephalalgia 2015;35:211–9.Search in Google Scholar

[3] Buse DC, Rupnow MF, Lipton RB. Assessing and managing all aspects of migraine: migraine attacks, migraine-related functional impairment, common comorbidities, and quality of life. Mayo Clin Proc 2009;84:422–35.Search in Google Scholar

[4] Krøll LS, Sjödahl Hammarlund C, Jensen RH, Gard G. Migraine co-existing tension-type headache and neck pain: validation of questionnaires. Scand J Pain 2015;8:10–6.Search in Google Scholar

Published Online: 2015-07-01

Published in Print: 2015-07-01

Articles in the same Issue

https://doi.org/10.1016/j.sjpain.2015.03.002