1. Differences in Patterns of Impairment, Psychiatric Comorbidity and Headache Beliefs in Migraine and Chronic Tension-type Headache Kathleen M. Romanek M.S., Kenneth A. Holroyd Ph.D., Connie Cottrell Ph.D., and Jana Drew Ph.D. Headache Treatment and Research Project Research has shown that both chronic tension-type headache and migraine sufferers have significant impairment and psychiatric comorbidity compared to compared to individuals without problem headaches. However, relatively little information is available comparing chronic tension- type headache and migraine and on these variables. Understanding the differences between chronic tension-type headache and migraine patients may assist health care professionals in the management of patients with these conditions. The purpose of this study was to examine the differences in headache impact, psychiatric comorbidity and beliefs about headaches in migraine (MI), chronic tension-type headache (CTTH), and healthy controls (HC). As expected, the CTTH group CTTHs had more frequent headaches than MI (26.0 vs. 8.5 d./mo, p<.001. Also, as expected, both CTTH & MI exhibited higher levels of impairment (on all 6 MOS-SF scales and the HDI) and higher levels of psychiatric comorbidity (PrimeMD) than HC (p<.05 for all tests). Overall, both CTTH and MI groups exhibited more psychiatric comorbidity than HC. Figure 1 shows the percentage of patients in each group diagnosed with a psychiatric disorder. Both CTTH and MI groups were more likely to be diagnosed with a depressive disorder than HC (ORs=4.76 and 2.36), ps<.05. Both CTTH and MI groups were also more likely to be diagnosed with an anxiety disorder than HC (ORs=21.28 and 7.30). Furthermore, significant differences between the CTTH and MI groups were also observed. CTTHs were more likely than MIs to have a depression or anxiety diagnosis (ORs=2.02 and 2.90). Figure 2 shows the HSLC and HSE means for CTTH and MI groups. The belief that improvements in headache were likely to depend on the actions of health care professionals was more prevalent in MI (m = 32.56) than CTTH (m=29.28), p<.001; however the belief that improvements in headache were likely to depend on internal factors was more prevalent in CTTH than MI (m=36.16 and 32.20), p<.001. In addition, participants with CTTH (m=70.63) were less confident in their ability to take actions to influence their headaches than were participants with MI (m=112.56), p<.001. Figure 1. Percentage of patients in each group diagnosed with a mood or anxiety disorder. Note: ** Indicates statistically significant from migraine and controls, p<.05. * Indicates statistically significant from healthy controls, p<.05 Figure 3. Percentage of those disabled in the CTTH and MI groups on the MOS-SF subscales. Notes: **Indicates statistically significant at p<.001. * Indicates statistically significant from healthy controls, p<.05. Figure 2. Headache Specific Locus of Control means for each headache group. Notes: **Indicates statistically significant at p<.001. Consistent with previous research examining psychological characteristics of headache sufferers, higher levels of impairment and psychiatric comorbidity were observed in both MI and CTTH than in HC. However, the pattern of psychiatric comorbidity and impairment differed in MI and CTTH. CTTH sufferers were more likely to have either an anxiety or depression diagnosis than MI sufferers. Furthermore, CTTH patients were also more likely to have mental health disability, pain-related disability, and perceptions of poorer health. On the other hand, MI patients reported more general headache-related disability and were more likely to exhibit disability in physical functioning and role (work) functioning. CTTH patients were less likely to believe that medical professionals could provide headache relief, were more likely to believe that internal factors could influence their headaches, and had less confidence in their ability to take actions to influence their headaches. Understanding the differences in the burden of headaches and differences in headache beliefs may help in understanding patient-related barriers to treatment. The 204 CTTH (78.0% female; 94.6% Caucasian; mean age= 37.04), 209 migraine (80.9% female; 91.4% Caucasian; mean age= 38.33), and 89 healthy controls (77.5% female; 89.7% Caucasian; mean age= 38.02) did not differ in demographic characteristics. Participants were administered self-report and interview measures assessing headache impact (Medical Outcomes Study, Short Form; MOS-SF; Headache Disability Inventory; HDI), psychiatric diagnosis (Prime- MD diagnostic interview) psychological symptoms (Beck Depression Inventory; BDI), and two types of headache beliefs: (a) beliefs about factors that influence headaches and headache relief (Headache Locus of Control; HLOC), and (b) the belief that they could take actions to influence their headaches (Headache Self-efficacy; HSE). ** * * * Background Method Results Conclusions In addition, significant differences in impairment emerged. Figure 3 shows the percentage of those disabled in the CTTH and MI groups on the MOS-SF subscales. Greater impairments in mental health (OR= 2.92), pain-related disability (OR= 3.59), and poorer health perceptions (OR= 1.56) were observed in CTTH than MI, ps<.05. Conversely, greater impairments in physical (OR= 16.13) and role functioning (OR= 83.33), ps<.05, was observed in MI than CTTH. In addition, greater headache-related disability (HDI) were observed in MI (m=50.45) than CTTH (m=39.68), p<.05.