Health-related quality of life in tension-type headache: A population-based study

Sait Ashina, Dawn C. Buse, Jakob B. Bjorner, Lars Bendtsen, Ann C. Lyngberg, Rigmor H. Jensen, Richard B. Lipton

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Objectives: Tension-type headache (TTH) is the most prevalent primary headache disorder. We assessed the cross-sectional impact of TTH on health related quality of life (HRQoL) in a general population. We also examined the association of HRQoL scores with headache frequency, disability, medication overuse, poor self-rated health, psychiatric comorbidity, and pain sensitivity in individuals with TTH. Methods: A sample of 547 subjects completed a headache diagnostic interview, the SF-12 to calculate physical (PCS) and mental (MCS) health component scores, depression (major depression inventory [MDI]) and neuroticism (Eysenck Personality Questionnaire) measures. We defined the following headache diagnosis categories: pure TTH, pure migraine, and coexistent headache (TTH + migraine). Cases were further classified into chronic (≥15) or episodic (<15 headache days/month). Results: Using generalized linear models (GLM) adjusted for age, sex and education, both PCS-12 and MCS-12 scores varied in groups distinguished by migraine and TTH status; scores were lower for individuals with coexistent headache (TTH + migraine; n=83), followed by pure TTH (n=97) and pure migraine (n=43) compared to the no headache group (n=324) (p≤0.001). In analyses considering chronicity, PCS-12 scores were lower in chronic coexistent headache followed by pure chronic TTH (CTTH), episodic migraine +/- episodic TTH (ETTH) and pure ETTH than in the no headache group (p≤0.001). MCS-12 scores were lower in pure CTTH, followed by chronic coexistent headache, episodic migraine +/- ETTH and pure ETTH compared to the no headache group (p≤0.001). Multiple regression models showed that in TTH, lower PCS-12 scores were associated with age (p=0.04), female sex (p=0.02), and poor self-rated health (p≤0.001). Lower MCS-12 scores in TTH were associated with depression (p≤0.001). Conclusions: In a population sample, TTH, and to higher degree CTTH, are associated with decreased HRQoL.

Original languageEnglish (US)
Pages (from-to)778-787
Number of pages10
JournalScandinavian Journal of Pain
Issue number4
StatePublished - Oct 1 2021


  • depression
  • migraine
  • pain sensitivity
  • quality of life
  • tension-type headache

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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