FINAL REPORT: Design and validation of a headache questionnaire for the SAGA Cohort study: Psychological Stressors and their Association with the Life-course of Migraine and its Comorbidities – a Longitudinal Study

Summary

Psychological stress is a powerful determinant of human behavior, physiology and health. Stress is also a well-known trigger for the occurrence of migraine episodes. Yet, in spite of decades of research, the evidence-base for the role of psychological stress in migraine development— its initiation, changes in migraine attack symptoms and association with comorbidities on a population level— remains uncertain.

The objective of the current project was to design and validate a migraine questionnaire that will be included in the very large and comprehensive population-based SAGA Cohort study of 100,000 Icelanders over 10 years. One major focus of the Saga Cohort study is the evaluation of stress and cancer development. With this project, we will be able to add a section on stress and migraine to advance the current knowledge of the potential role of psychological stress on migraine development and its association with migraine comorbidities.

To validate our questionnaire, subjects reporting headache in the past year and subjects not reporting headache were subsequently interviewed by a neurologist. Results from using our screening questionnaire were then compared with results from the interviews with the neurologist to determine   how well the questionnaire performed. It was validated.

Hypothesis vs. Findings

We hypothesized that we would be able to identify people with migraine from a population sample using a questionnaire. The self-administered screening questionnaire that we developed identified migraine with a high sensitivity and specificity as compared to a neurologist interview, the diagnostic gold standard. This means that the questionnaire alone can be used to identify people with migraine in the large population-based SAGA Cohort study.

We proposed that our screening questionnaire would be able to differentiate subjects who experienced migraine with aura, which consists of visual and or sensory symptoms, from those with migraine without aura. The screening questionnaire identified migraine with aura with moderate sensitivity and high specificity, which means that the questionnaire can be used to identify subjects with migraine with aura.

Unanswered Questions

Subjects with migraine often have other types of headache. Due to a limited number of potential questions that could be included in the questionnaire, we cannot determine if subjects have other types of headache too. If subjects reported more than one type of headache, they were asked to report only on their worst headache. Since migraine is highly prevalent and associated with considerable pain, disability and reduced quality of life, we hypothesized it would be considered the “worst” headache and therefore would be reported when a subject has more than one type of headache.

To study potential effects of major stressors, we will examine past major life events, such as loss of a spouse, as a potential trigger for first onset of migraine or a trigger for progression from episodic migraine to chronic migraine. To examine potential effects during pregnancy we will compare birth records of head size among participants with migraine versus those without, and study comorbidities among participants with both migraine and depression. Special attention will be given to modifiable risk factors that increase migraine symptoms and frequency, such as sleep problems, obesity, co-morbid pain conditions and excessive use of medications.

What this Research Means to You

People with migraine often have greatly reduced quality of life, and many have comorbidities. Compared with most other diseases and conditions, migraine has one of the highest reductions in quality of life. Despite all this suffering associated with migraine, research in the field of migraine remains very underfunded. This research has the potential to advance the understanding of how stress modulates migraine development, progression (and remission), and how stress and migraine interact in relation to migraine comorbidities. By gaining a better understanding of how stress affects migraine, we will be better equipped to treat migraine and its comorbidities.