Underdiagnosis and the impact of headache-related disability on the quality of life patients

ABSTRACT

To determine the extent of under-diagnosis of migraine and the impact of headache-related disability on the quality of life of patients. Prospective, Observational. This study was conducted at the Department of Neurology, Medical Unit II, PUHMS, Nawashah from 1.1.2009 to 31.12.2009. The demographic and clinical data was collected in a proforma. Migraine was diagnosed according to the International Headache Society Classification. Neurological examination and routine laboratory tests were done in all cases. CT Scan of brain was performed whenever deemed necessary. A clinically reliable Migraine Disability Assessment Scale [MIDAS] was administered to the patients with migraine headache. The disability was rated as Grade I [little or no disability] to Grade IV [severe disability] based on the information provided by the patients. Sixty-eight cases were documented. Male=31, Female = 37. Age ranged from 10-59 years. The majority were in the age group of 10-39 years. Fifty-seven [83.8%] had migraine without aura [common migraine] while 11/68 [16.2%] had migraine with aura [classic migraine]. In 36/68 [52.9%] nausea was the most frequent associated symptom. Photophobia [17.6%] was more common than phonophobia [5.8%]. Visual changes [flashing lights] was the most common associated symptom in migraine with aura. Stress was the most frequent triggering factor in majority in 29.4%. Only 8/68 [11.7] were previously diagnosed as they were taking some anti-migraine therapy whereas majority 60/68 [88.3%] were newly diagnosed at the time of our assessment. The usual frequency of headache was once/week in 30/68 [44.2%], once/2 weeks in 22/68 [32.3%] and once/month in 16/68 [23.5%]. Disability was Grade I in 8/68 [11.7%], Grade II in 12/68 [17.6%], Grade III in 30/68 [44.2%] and Grade IV in 18/68 [26.5%]. Most of our cases were unaware of their illness nor they were provided relevant information by their physician regarding migraine and its associated aspects. This study indicates that migraine is under diagnosed in a greater proportion of cases in our region. The headache-related disability caused by migraine adversely affects the quality of life of patients. Unawareness about the disease appears to be the main reason for under diagnosis and increasing disability in our patients