Risk Factors For Chronicity Of Common Primary Headaches

[Objective]:To analyze the risk factors for chronic headache by observing the clinical characteristics of patients with common primary headaches,including tension type headache(TTH),migraine(M)and new daily persistent headache(NDPH).[Method]:This study analyzed 150 patients with TTH,570 patients with M and 51patients with NDPH according to diagnostic criteria of international headache society(IHS)in Renji Hospital,School of Medicine,Shanghai Jiao Tong University,from October 2016 to October 2018.The headache questionnaire should be recorded.Serum 25(OH)D concentration was measured by liquid chromatography tandem mass spectrometry(liquid chromatography tandem mass spectrometry,LC-MS/MS).Patients could be divided into the paroxysmal headache group and chronic headache group according to headache frequency.All data statistical analysis was conducted using SPSS23.0 software.K-S test was used for the test of normality.The measurement data conforming to the normal distribution were expressed as mean standard deviation,and analysis of variance or t test was used for the comparison between groups.Enumeration data were expressed as examples or percentages,and comparison between groups was conducted byχ~2 test.The factors with p<0.05 in the univariate analysis were analyzed by multivariate Logistic regression.p<0.05 was considered statistically significant.[Results]:(1)A total of 771 patients with primary headache were included in this study.There were 570 M with an average age of 40.81±15.71 years,and 82.28%of them were female,including 132 CM and 438 paroxysmal M.There were 150 patients with TTH with the average age of 45.95±14.39 years,and 57.33%of them were female,including111 CTTH and 39 paroxysmal TTH;moreover,51 patients with NDPH were enroll,which 60.78%were female.There were 23 M-like NDPH(NDPH-M)(45.10%)and 28TTH-like NDPH(NDPH-TTH)(54.90%).(2)Univariate analysis show that CM patients were older than paroxysmal M(45.59±12.04 vs.39.38±16.41,p<0.001).And there were more anxiety disorder(13.64%vs.4.79%,p<0.001),depression disorder(10.61%vs.4.115,p=0.003),hypertension(10.61%vs.4.115,p=0.003),and sleep disorders(31.06%vs.10.50%,p<0.001)and medication overuse(53.03%vs.3.42%,p<0.001)in CM.Multivariate analysis suggested that patients with medication overuse were 29.174 times more likely to have CM than not(OR:29.174,95%CI:14.745-57.719,p<0.001).Patients with sleep disorders were 2.076 times more likely to develop CM than those without sleep disorders(OR:2.076,95%CI:1.043-4.130,p=0.038).Other indicators,such as age at the beginning of headache,headache severity,family history,hyperlipidemia,and bone and joint disease,showed no statistical difference(all p>0.05).There was no significant difference between the two groups in the season and the level of vitamin D(p>0.05).(3)Univariate analysis suggested that there was more hypertension(23.42%vs.10.25%,p=0.028)and medication overuse(24.32%vs.7.69%,p=0.026)in CTTH than paroxysmal TTH.However,the level of vitamin D in patients with paroxysmal TTH was significantly higher than that in patients with CTTH(18.68±6.64 vs.15.51±6.35ng/ml,p=0.020).Multivariate analysis suggested that patients with hypertension were6.991 times higher risk of CTTH than those without hypertension(OR:6.991,95%CI:1.208-40.470,p=0.030).Patients with medication overuse were 5.252 times more likely to have CTTH than those without medication overuse(OR:5.252,95%CI:1.288-21.425,p=0.021).Higher vitamin D level is a protective factor for CTTH(OR:0.915,95%CI:0.846-0.989,p=0.026).Other indicators,such as age at onset of TTH,family history,anxiety disorder,depressive disorder,hyperlipidemia,bone and joint disease,sleep disorders,and vitamin D levels,showed no statistically significant difference between the two groups(all p>0.05).(4)Univariate analysis indicated that more anxiety disorder(25.49%vs.5.88%,p=0.043)and depression disorder in NDPH patients than PH(31.37%vs.5.88%,p=0.009).Multivariate analysis suggested that patients with depression disorder were13.674 times more likely to develop NDPH than those without depression(OR:13.674,95%CI:1.550-120.630,p=0.019).Other indicators,such as age at the onset of headache,family history,hypertension,hyperlipidemia,bone and joint disease,sleep disorders and vitamin D levels,showed no significant difference between the two groups(all p>0.05).[Conclusion]:(1)Sleep disorders and medication overuse are independent risk factors for CM;(2)Hypertension and medication overuse are independent risk factors for CTTH,but high vitamin D level is a protective factor for CTTH;(3)Depressive disorder is an independent risk factor for NDPH.