EVOLUTION OF THE MEASUREMENT OF QUALITY-OF-LIFE IN MIGRAINE

Although headache is among the most common pain complaints seen by phy sicians, the measurement of health-related quality of life (HRQoL) in headache patients is in its earliest stages. Two types of questionnair e have been used to measure HRQoL in headache sufferers: general and d isease-specific instruments. General quality-of-life (QoL) instruments use scales to assess QoL with respect to a number of activities withi n physical, social, psychological, and behavioral life domains. Diseas e-specific instruments reflect particular limitations or restrictions associated with specific disease states. These instruments are designe d to be most sensitive in determining the effects of treatment or the longitudinal course of disease. Data from the Medical Outcomes Study S hort Form (SF)-20 and SF-36 generic QoL instruments demonstrated that chronic headache disorders were associated with significant limitation s in all eight health domains of patient wellbeing and functioning. Th e SF-20 outcomes profiles for each of the common benign headache disor ders (migraine, tension-type headache, mixed headache, and cluster hea dache) appear to be unique for the specific headache diagnosis. The SF -20 and SF-36 were also used to compare headache disorders with other chronic illnesses. Chronic headache disorders, including migraine, wer e found to cause significantly more impairment of function than diabet es, hypertension, osteoarthritis, and low back pain. Preliminary studi es of QoL during pharmacologic therapy have suggested that disease spe cific instruments may be more sensitive than generic instruments for e valuating the longitudinal impact of treatment. Generic QoL instrument s, such as the SF-20 or SF-36, may be more useful to define population s being studied than to measure changes in the population over time. T he publication of headache-specific QoL instruments, which have been w idely used in clinical trials and have been validated, is awaited. Unt il such time, the SF-36 will remain the standard measure of QoL in hea dache.