Impact ofChronic Headache( Migraine) onDaily Activity of Adult Patients in Baghdad City

Objectives: The study aimstoassess the impact of(migraine) on the daily activityof patients withmigraineatprimary health care centersin Baghdad city,and to findout the relationship between their demographic characteristicswhich as age, sex, occupation, family history . Methodology : A descriptive study was conducted to assess the impact of (migraine) on the daily activity of adultpatients in primary health care centers in Baghdad city. The study was conducted from 1st September, 2012 to March18th, 2013.The study sample included 100patients were collected from four centers of primary health care in Baghdad city. The data was collected through the use of constructed questionnaire, which consists of two parts. Part I : deals the socio-demographic characteristics which as 6 items: gender, age, marital status, occupation , using of drugs and duration of headache attack.Part II: quality of life questionnaire assessment tool was used to measure the extent to which chronic headache are affecting the ability to function. Results: The results showedthat more thanhalf of thosestudymales(60%), while theiragefor more thanone-third ofthe samplerangedfrom20-30years (38%).More thanhalf of themaremarried (58%).Thestudy also showed thatnearly half ofthe study samplewasemployed(56%), while theuse ofthe vast majority ofthe study sampleuse medications (90%). Conclusions: Most of the affected by headache were males,greatest of clients who suffer from chronic headache was using medications. Majority of the patients have headache attack lasted less than one day. Recommendations: The study recommendedthe needto conductregular monitoring ofchronicheadachein order tohelpto reducethe problems andcomplicationsthat can ariseas a result ofa headache, andthere will be aneedto theimplementation ofeducational programsfor the diagnosis ofheadachesand how totreat.


INTRODUCTION
Migraine is a common and often devastating neurologic disorder.Epidemiologic research data describing that the prevalence and distribution of migraine can be used to assess the burden of disease and the quality of medical care (1).
Migraine affects millions of individuals worldwide, generally during the most productive years of a person's life.Studies show that migraineurs are underdiagnosed, undertreated, andexperience substantial decreases in functioning and productivity, which in turn translates into diminished quality of life for individuals, and financial burdens to both health-care systems and employers (2).Now recent clinical studies suggest that migraine may be a progressive disease with cardiovascular, cerebrovascular, and longterm neurologic effects (2).
In 1989, the American Migraine Study was the first study in the United States to provide a population-based estimate of migraine prevalence using a case definition based on the International Headache Society (IHS) criteria.This study exposed that approximately 18% of women and 6% of men suffered from migraine, for an estimated 23.6 million Americans with migraine.(3).Over the past decade, many new treatments for migraine have become available, and the knowledge of migraine has improved.Various studies suggest that the prevalence of migraine may be increasing for reasons that have not been elucidated.In addition, over the last decade, many initiatives to educate physicians and patients about migraine have been launched.Given these developments, we reevaluated the epidemiology, the burden, and the patterns of health.The American Migraine Study, describe the epidemiology of migraine in the United States circa 1999 to determine if its prevalence, sociodemographics, or burden have changed over the last decade(4).Headachesmigraine vary broadly in terms of severity, frequency, and disability-from rare episodes of minor discomfort to daily, incapacitating headaches .The most common type of headache is tension-type headache, in terms of work loss and decreased quality of life, is high among thosewho experience tension-type headache, with 10% reporting lost workdays and almost half reporting decreased effectiveness at work, home, or school (5).
In general, a migraine is a very bad headache that tends to come back.It may occur as often as several times a week or only once every few years.It can last anywhere from a few hours to 3 days.The amount of pain can vary.Some migraines can be fairly mild, while others seem almost unbearable.In addition, you may be very sensitive to bright lights, noises, and even smells when you have a migraine.Moving around, especially making rapid movements of the head, can make your headache feel worse (6).Some studies show that 5% to 12% of the population in the different countries were classified as suffering from migraine.Approximately one-half of all migraineurs did not seek medical advice (7).
Migraine is also affecting about 11% of adult populations in Western countries.Prevalence is highest during the peak productive years between the ages of 25 and 55.Prevalence of active cases of migraine increases steadily from infancy until approximately 40 years of age and peaks between ages 35 and 45 in both males and females and declines thereafter (8).

Objective of the study:
The present study is designed to achieve the following objectives: 1.To measure the extent to which the chronic headache(migraine)will affects on daily activity at clients with migraine.2. To identify the relationship between theirsociodemographicalcharacteristics of age, gender, occupation, marital state, family history and the extent of migraine.

METHODOLOGY Design of the Study:
Non experimental design adescriptive study was carried throughout to measure the impact of chronic headache on daily activity forpatients with chronic headache .The study is conducted from September 1 st , 2012 to March 18 th , 2013.

Setting of the Study:
The study was carried out in Primary Health Center in Baghdad City.

The Sample of the Study:
The randomly sample of (100) patients with chronic headache (migraine ) who attended toPrimary Health Center in Baghdad City through the use of questionnaire and interview technique.

The Study Instrument:
A questionnaire was designed and constructed by the researcher to measure the effect of chronic headache on daily activity.Final study instrument consist two parts: Part I : the first section was socio-demographic characteristics that consist of 6 items: gender, age, marital status, occupation, using of medications and duration of headache attack.Part II:Questionnaire tool that was used to measure the extent to which chronic headache (Migraine) are affecting the ability to function normally.

Data Collection:
The data were collected through the use of self-administered questionnaire.The data collection process has been performed from Feb. 11 th 2013 until Mar.19 th 2013.

Ratting and scoring:
The items have been rated and scores according to the following patterns.Six point liker scales is used for rating the instrument scales consist from items scored as (1) for none of the time, (2)for A little bit of the time, (3) for Some of the time ,(4) for A good bit of the time, (5) for Most of the time and finally (6) for All of the time.Finally the rating cut off point used to this scale (mild=27 ; moderate=28-56 and severe more than 57).This table showed that more than half of the study subjects were males (60%).Concerning to the age more than third of sample was ranged from 15-25year (38%), regarding to the marital status more than half of the study sample was single (58%).The study also showed that about half of the study sample were employments (56%).While the majority of the study sample was used drugs (90%).Approximately more than half of the study sample suffer from headache attack that persistence less than one day (58%).2 shows that duration of headache attack, more than half of clients has headache attack that persist less than one day (58%), For more than one third of the sample, chronic headache interfered with the ability to deal with family, friend, and who are close to whom was a little bit of time (38%).

RESULTS:
While the headaches interfered a little bit of time with leisure activities for (40%) of sample, (30%) of samples have some of time have negative effects on performing the daily activities.This table indicates that there was a significant relationship between the items of the chronic headache and socio-demographic characteristics except the using of drugs and the duration of headache attack.

DISCUSSION:
Presents a systemically organized interpretation and reasonably derived discussion of results with the support of available literatures and related studies.
Regarding gender, the results showed that the more half of sample was males (60%).This result similar toa study done byVillalon, they found that the most percentage of gender that affected by headache were males(70%) ( 9).Concerning the age, the study showed that more than third of study sample was ranged from 21-30 year (38%).This result similar to-O'Brien, they found that the age ranged from 20 to 40 year (10).Concerning to the marital status, more than half of the study sample were single (58%).This results similar toVillalon, they found that more than two third of their study sample was single (61.2%) (9).Regarding to the occupational status, about more than half of the study sample was employed (56%).This result supported byLoeppke, they found in their study that great percentage of the study sample was employed (72.4%) ( 11).Concerning to use of drugs our study depicts that great percentage of clients who suffer from chronic headache was using medications (90%), our results approximately similar toVillalon, who found that most of their study sample was using drugs (73.6%) (9).
Regarding to the duration of headache attack our study found that more than half of clients has headache attack that persist less than one day (58%), the study which similar to our result which producedTerwindt, they found that more than two third of their study sample have a duration of headache attach that persist less than one day (63.2%)(4).About (38%) of samples have some of time influencing the doing of home or work activities, and some of time the headaches limit the abilities to concentrate on work or daily activity about (34%) of samples.
Headaches left (34%) of samples too tired was a little bit of time, the headaches limit a little bit of time the energetic days about (30%) of samples, a little bit of time for (38%) of samples forced to cancel the work or daily activity because of headaches.
Need help to complete their routine tasks was a little bit of time because of headaches (34%).Some of the time for thirty samples forced to stop their activities because of chronic headache.For (32%) of samples were not able to attend social activities approximately was some of the time.(36%) of samples have a little bit of time felt frustrated because of headache, regarding (28%) of sample felt burden on other were some of the time.None of the time for (54%) of samples were not afraid of letting another down because of chronic headache.
Present study showed that there was a significant association between gender and chronic headache where a (70%) of clients a moderate level of chronic headache.This result similar to Steiner, et al (2003), they found a significant correlation between gender and chronic headache (76.5%).
According our study there were a significant relationship between chronic headache and age where a (70%) of clients were with moderate level of chronic headache.This study similar to (5), they found a significant correlation between age and chronic headache (80.1%).
Regarding to marital status our study found a significant association between chronic headache and marital status where a (70%) of our study sample where with a moderate level of chronic headache.our study similar to (12), they found a correlation between marital status and chronic headache (56%).
Concerning to the occupational status in our study a higher significant between chronic headache and occupation there was a (70%) of clients were with moderate level of chronic headache.This results similar to (13), they found a great correlation between occupation and chronic headache (81.6%).In our study there is no correlation between drug using and chronic headache.This study near to (14) they produced study about diagnosis and treatment of chronic headache.Our study showed there was no correlation between duration of headache attack and the chronic headache.This approximately similar to LeonardiandMatherswho founds in their study prevalence and characteristics of migraine the clients were suffered from 12 attacks per year.(15)

CONCLUSIONS:
Most of gender affected by headache were males.More than half of the study sample were single and greatest of clients who suffer from chronic headache was using medications.Majority of the patients have headache attack lasted less than one day and that there were strong relationship between migraine and occupation.

RECOMMENDATION:
1-Regular monitoring of migraine will help to prevent problems and complications 2-The prospective studies would be needed in order to increase information about migraine 3-Need to produce health programs to provide awareness on migraine and how to deal with it.4-Future research should also focus on ways of increasing clients' ability to cope with the stressors of migraine.5-Physiological and psychological counseling to clients promote clients health status and reduce the effect of headache attack.