This study provides, for the first time, a comprehensive assessment of the HRQoL and its associated factors in Chinese patients with MM. We found that the HRQoL in MM patients is lower in five dimensions of HRQoL (PF, RF, GH, SF, MH) compared with NMM patients. In addition, in the stepwise linear regression model, we found that PCS is related to headache frequency, depression symptoms, the impact of headache on daily life. MCS is related to depression symptoms, suicidal ideation, social support in MM patients. Such findings point the way to scientific strategies to improve HRQoL for MM patients.
Migraine increases the burden of patients, and seriously affects the life quality of patients. Nicodemo et al. used SF-36 to evaluate the life quality of MM, and found the scores of MM in the six dimensions of HRQoL (PF, RP, BP, GH, VT, SF)were lower than those of healthy women, and there is no significant difference in the scores of the two dimensions (RE, MH). Based on the severity and refractory of MM, we performed subgroup analysis of migraine to compare the HRQoL in patients with MM and NMM. We found MM patients had lower mean scores for the five dimensions (PF, RF, GH, SF, MH) compared with NMM patients, and there were no statistically significant differences in scores for the three dimensions (BP, VT, RE). In addition, patients with MM scored lower than NMM for both PCS and MCS.
Our study demonstrated that depression symptoms are independently associated with PCS and MCS, after adjusting the confounding factors. Depression is a common comorbidity in migraine patients, and HRQoL was reduced in patients who had both migraine and depression relative to migraine patients who were not depressed. A recent study in the United States found that depression symptoms are a predictor of headache frequency and migraine-related disability. Hence, it is not difficult to understand that depression symptoms are closely associated with physical and mental health. In agreement with the study finding in Brazil, we demonstrated that the severity of depression symptoms is a predictor of HRQoL among MM. Pradeep et al. reported the presence of depression was noted to add to the magnitude of migraine-related disability and diminished the quality of life in migraine patients, which is similar to the results of our study. This study also found that anxiety had a negative impact on the quality of life of patients who suffer from migraine. In our study, although univariate analysis showed that anxiety symptoms may be a significant risk factor for HRQoL in MM patients, no significant difference was detected by multivariate analysis. At present it cannot be certain that anxiety symptoms are independently associated with HRQoL among MM patients.
MM patients who reported more frequent migraine attacks and greater impact of headaches on daily life could impair HRQoL by affecting their physical health. A downward trend in the quality of life of migraine was noted with the increased headache frequency. Previous study has proved that the more frequent migraine attacks and greater impact of headaches on daily life were predictors of detrimental effects on quality of life in migraine patients, which is similar to our results. In a recent study, Irimia found that a positive linear association between headache frequency and the risk of anxiety, depression in migraine patients. Patients with monthly headache days ≥ 3 days are at higher risk of anxiety, while those with ≥ 19 days are at risk of depression. Moreover, patients with monthly headache days ≥ 10 days are often accompanied by severe disability. It is interesting to note that patients experiencing only one to six headaches per year still show a reduction in quality of life, it might be due to the unpredictability of attacks that magnifies the effect of the few headache days on quality of life in a remarkable way. Richard et al examined the association between headache-free days and the disease burden of migraine, and found headache-related disability shows a decrease tendency with the headache-free days increasing.
Our research showed that the perception of social support is positively associated with MCS. An Italian study of chronic migraine patients with medication overuse found that social support is a predictor of the quality of life to some extent. Moreover, a French study also found that the higher perceived social support was, the higher the probability of being an active consulter for migraine[27, 28]. Such headache counseling allowed patients to actively take prevention and treatment strategies to minimize the burden of migraine and relieve adverse emotions, and thus engaged more in social activities and improved HRQoL, especially in mental health related HRQoL.
As the limitations of daily social and work-related activities caused by migraine, the mental health of patients was impacted, and severe cases may lead to suicidal ideation. Our research found that suicidal ideation can affect MCS and could consequently predict HRQoL of MM patients. Many scholars agreed that migraine patients are associated with a poor quality of life and a higher likelihood of suicidal ideation[8, 9, 29, 30]. This study demonstrated, for the first time to our knowledge, the correlation between HRQoL and suicidal ideation among MM patients. Providing psychological treatment to MM patients with suicidal ideation may help to reduce suicide risk, as can the application of active treatment, improving their mental health and HRQoL.
Sleep disturbance, as a clinical triggers for migraine, is associated with migraine, creating a vicious cycle. Although sleep quality is associated with the PCS and MCS of patients with MM in the univariate analysis, it is no longer a significant associated factor after adjusting for the potential confounders in the multivariate model. Thus, we cannot consider sleep quality as a predictor for HRQoL in MM patients. In the current study, the evidence describing the relationship between sleep quality and HRQoL was still insufficient among migraine patients,and this result was in line with the previous study.