Health-related quality of life, disability and severity of disease in patients with migraine attending to a specialty headache center

Background.- The impact of migraine on patients' daily life has been evaluated in several studies. The relationship between disability and health-related quality of life (HRQoL) in patients with migraine, however, has not been systematically evaluated. Objective.- To assess the impact of migraine on patients' HRQoL and disability patterns and to describe the relationship between disability and HRQoL in patients with migraine attending a specialty Italian headache center according to the biopsychosocial model of disability endorsed by the International Classification of Functioning, Disability and Health. Methods.- In this observational study, adult patients with migraine were consecutively recruited. Disability was measured with the MIDAS (Migraine Disability Assessment) and the WHO-DAS II (World Health Organization Disability Assessment Schedule), HRQoL with the SF-36 (Medical Outcome Survey 36-item Short-Form Health Survey). Spearman's rank correlation between MIDAS score, SF-36 and WHO-DAS II scales was performed to evaluate the relationships between quality of life and disability. The impact of migraine on disability and HRQoL was assessed by comparing WHO-DAS II and SF-36 scores against Italian normative values, and by evaluating the different disability and HRQoL profiles in patients with different severity of migraine, defined according to migraine frequency and pain intensity. Results.- A total of 102 patients with migraine (87 females) were enrolled. Mild to moderate correlations were reported between WHO-DAS II and SF-36's PCS (r = -0.67, P <.01) and MCS (r = -0.36, P <.05) scales; MIDAS score correlations to SF-36's PCS (r = -0.44, P <.01) and MCS (not significant) were lower than WHO-DAS II summary score. The correlation between MIDAS score and the WHO-DAS II summary score was mild (r = -0.36, P <.05). The majority of HRQoL and disability scales (with the exception of SF-36's Physical Functioning, and WHO-DAS II Getting along with people scales) scored significantly lower than normative values. A trend towards worsening of both HRQoL and disability, consistent with increasing migraine severity, was reported (Mann-Whitney's U = 119.5 for MIDAS; U = 113.0 for WHO-DAS II summary score, both with P <.01; U = 152.9 for PCS; U = 171.0 for MCS, both with P <.05) Conclusions.- In migraineurs attending an Italian specialty headache clinic, disability scores were worse and HRQoL scores lower than those of the general population, and worsened consistently with increased migraine severity. Measures of HRQoL and disability evaluate different psychosocial aspects of migraine and researchers should continue to employ them in public health and clinical research on migraine. They provide information on a poorly recognized part of migraine's burden, where economic impact is minimal but there are important effects on patients' daily lives in terms of interpersonal relationships, perceived quality of life and emotional status.