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Contribuição da ansiedade e depressão na autoavaliação do impacto da enxaqueca através do HIT-6
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A enxaqueca é uma doença altamente prevalente e com um impacto negativo em vários domínios da vida dos indivíduos e na qualidade de vida em geral. Embora seja frequentemente associada à ansiedade e depressão, a influência exata destas condições na autoavaliação do impacto dos ataques de enxaqueca permanece incerta. Para determinar esse efeito, realizamos um estudo observacional prospetivo em doentes com o diagnóstico de enxaqueca, com a hipótese de que níveis mais elevados de ansiedade e depressão podem influenciar a perceção do impacto das crises.
Foram incluídos doentes adultos com enxaqueca seguidos na consulta de Cefaleias do Hospital de Santa Maria. Após a obtenção do consentimento informado, foram recolhidas variáveis demográficas e clínicas e os doentes preencheram os questionários: Hospital Anxiety and Depression Scale (HADS), que avalia os níveis de ansiedade e depressão, o Headache Impact Test 6 (HIT-6) que mede o impacto da enxaqueca em seis áreas da vida dos pacientes e o Headache-Attributed Lost Time (HALT) que quantifica o número de dias que os indivíduos perdem ou não conseguem realizar as suas atividades habituais devido à enxaqueca. Foram excluídos doentes com outras comorbilidades psiquiátricas ou outras síndromes dolorosas. Foi analisada a correlação das diferentes perguntas e da pontuação total do HIT-6 com a escala HADS e identificadas as variáveis explicativas do impacto das crises por análise multivariada.
Duzentos pacientes foram incluídos neste estudo, 92% (N=184) eram do sexo feminino, com uma mediana de idades de 47 anos (IQR=36-52), e 53% (N=105) tinham enxaqueca crónica. A mediana das pontuações do HIT-6 foi de 64 pontos (IQR=60-68) e a mediana das pontuações do HADS foi de 17 pontos (IQR=11-22). Na análise multivariada, verificou-se que 14.1% da pontuação do HIT-6 foi explicada pela ansiedade e 6.5% pelo Index, ajustando para a frequência e intensidade das crises, idade, idade de início da enxaqueca, sexo, anos de escolaridade e número de dias mensais com uso de medicação de resgate. Isto sugere que, principalmente, a ansiedade tem um impacto em como os indivíduos avaliam o impacto dos ataques de enxaqueca.
Conclusão: A ansiedade pode aumentar a perceção subjetiva do impacto da enxaqueca, potencialmente influenciando a gestão dos pacientes.
Migraine is a highly prevalent disease with a negative impact on several domains of individuals’ lives and overall quality of life. While it is commonly comorbid with anxiety and depression, the exact influence of these conditions on self-assessment of the impact of migraine attacks remains unclear. To determine this effect, we conducted a prospective observational study involving patients with migraine. Therefore, we hypothesize that higher levels of anxiety and depression may exacerbate the impact of migraine attacks. Adult patients with migraine followed in the Headache Clinic of Hospital Santa Maria were enrolled in the study. After obtaining informed consent, demographic and clinical variables were collected. Patients completed self-administered questionnaires: the Hospital Anxiety and Depression Scale (HADS), assessing levels of anxiety and depression, the Headache Impact Test 6 (HIT-6), measuring the impact of migraine on six areas of patients' lives, and Headache-Attributed Lost Time (HALT) that quantifies the number of days that individuals miss or cannot perform their usual activities due to migraine. Patients with other psychiatric comorbidities or other painful syndromes were excluded. The correlation between different questions and the total HIT-6 score with the HADS scale was analysed, and variables that may explain the perceived impact of headache attacks were identified through a multivariate analysis. Two hundred patients were included in this study, 92% (N=184) were female, with a median age of 47 (IQR=36-52) years, and 53% (N=105) had chronic migraine. The median HIT-6 score was 64 (IQR=60-68) points, and the median HADS score was 17 (IQR=11-22). In the multivariate analysis, it was found that 14.1% of HIT-6 score was explained by anxiety, and 6.5% by the Index, while adjusting for attack frequency and intensity, age, age of migraine onset, sex, years of education, and monthly days of rescue medication usage. This suggests that mainly anxiety does have an impact on how individuals assess the impact of migraine attacks. Conclusion: Anxiety may heighten the perception of migraine impact, potentially influencing patient management.
Migraine is a highly prevalent disease with a negative impact on several domains of individuals’ lives and overall quality of life. While it is commonly comorbid with anxiety and depression, the exact influence of these conditions on self-assessment of the impact of migraine attacks remains unclear. To determine this effect, we conducted a prospective observational study involving patients with migraine. Therefore, we hypothesize that higher levels of anxiety and depression may exacerbate the impact of migraine attacks. Adult patients with migraine followed in the Headache Clinic of Hospital Santa Maria were enrolled in the study. After obtaining informed consent, demographic and clinical variables were collected. Patients completed self-administered questionnaires: the Hospital Anxiety and Depression Scale (HADS), assessing levels of anxiety and depression, the Headache Impact Test 6 (HIT-6), measuring the impact of migraine on six areas of patients' lives, and Headache-Attributed Lost Time (HALT) that quantifies the number of days that individuals miss or cannot perform their usual activities due to migraine. Patients with other psychiatric comorbidities or other painful syndromes were excluded. The correlation between different questions and the total HIT-6 score with the HADS scale was analysed, and variables that may explain the perceived impact of headache attacks were identified through a multivariate analysis. Two hundred patients were included in this study, 92% (N=184) were female, with a median age of 47 (IQR=36-52) years, and 53% (N=105) had chronic migraine. The median HIT-6 score was 64 (IQR=60-68) points, and the median HADS score was 17 (IQR=11-22). In the multivariate analysis, it was found that 14.1% of HIT-6 score was explained by anxiety, and 6.5% by the Index, while adjusting for attack frequency and intensity, age, age of migraine onset, sex, years of education, and monthly days of rescue medication usage. This suggests that mainly anxiety does have an impact on how individuals assess the impact of migraine attacks. Conclusion: Anxiety may heighten the perception of migraine impact, potentially influencing patient management.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Enxaqueca Ansiedade Depressão Hospital Anxiety and Depression Scale (HADS) Headache Impact Test 6 (HIT-6) Neurologia