Psychosocial aspects of chronic daily headache.

The objective was to investigate possible psychosocial factors in chronic daily headache (HA) by comparing those with chronic daily HA to matched patients with chronic episodic HA and to matched non-HA controls. Although there is some research on psychosocial factors in chronic daily HA, it is conflicting and none to date has compared such patients to both an episodic HA control and a non-HA control. Nineteen patients with chronic daily HA (less than 2% of 4-times-per-day HA ratings were zero) were compared to 19 HA patients matched on age, gender and nominal IHS diagnoses, and to 16 similarly matched non-HA controls on measures of psychological distress (MMPI, BDI, STAI), measures of life stress (major past events, hassles, prospective daily stress) and quality of life (SF-36). Those with chronic daily HA were significantly more distressed and had significantly poorer function on most measures relative to non-HA controls. Although there were many arithmetic trends for chronic daily HA to be more distressed and to function less well than those with episodic HA, only on the depression and social introversion scales of the MMPI and the overall vitality rating of the SF-36 were the differences significant. All three groups had comparable levels of life stress regardless of how it was measured. Those with chronic daily HA have greater levels of psychological distress and poorer quality of life than those with episodic HA or non-HA controls, despite comparable levels of life stress.