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Impact of comorbidity on headache-related disability

From the Center for Health Studies (K.S., M.V.K.), Group Health Cooperative, Seattle, WA; Intramural Research Program (K.M., N.C.P.L.), National Institute of Mental Health, Rockville, MD; Department of Health Policy (R.C.K.), Harvard University, Boston, MA; and Department of Psychiatry (N.C.P.L.), McGill University, Montreal, Canada.

Address correspondence and reprint requests to Kathleen Saunders, Center for Health Studies, Group Health Cooperative, 1730 Minor Ave., Suite 1600, Seattle, WA 98101 saunders.k{at}ghc.org

Objective: To assess and compare the extent to which comorbid conditions explain the role disability associated with migraine and other severe headaches.

Methods: A probability sample of US adults (n = 5,692) was interviewed. Presence of headaches, other chronic pain conditions, and chronic physical conditions was assessed in a structured interview administered by trained interviewers. Diagnostic criteria for migraine were based on the International Headache Society classification. Mental disorders were ascertained with the Composite International Diagnostic Interview that collected diagnostic criteria according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Role disability was assessed with World Health Organization Disability Assessment Schedule questions about days out of role and days with impaired role functioning.

Results: Eighty-three percent of migraineurs and 79% of persons with other severe types of headache had some form of comorbidity. Compared with headache-free subjects, migraineurs were at significantly increased risk for mental disorders (odds ratio [OR] 3.1), other pain conditions (OR 3.3), and physical diseases (OR 2.1). Compared with headache-free subjects, persons with nonmigraine headache were also at significantly increased risk for mental disorders (OR 2.0), other pain conditions (OR 3.5), and physical diseases (OR 1.7). Migraineurs experienced role disability on 25.2% of the last 30 days compared with 17.6% of the days for persons with nonmigraine headaches and 9.7% of the days for persons without headache. Comorbid conditions explained 65% of the role disability associated with migraine and all of the role disability associated with other severe headaches.

Conclusions: Comorbidity is an important factor in understanding disability among persons with headache.

GLOSSARY: CIDI = Composite International Diagnostic Interview; GAD = generalized anxiety disorder; ICHD-II = International Classification of Headache Disorders, second edition; NA = not applicable; NCS-R = National Comorbidity Survey Replication; OR = odds ratio; PTSD = post-traumatic stress disorder; WHO = World Health Organization.

See the acknowledgment for complete funding and support information and a list of collaborating NCS-R investigators.

Disclosure: The authors report no conflicts of interest.

The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or US Government.

Received September 1, 2006. Accepted in final form July 19, 2007.