PREVALENCE OF CHRONIC DAILY HEADACHE (CDH) IN PEOPLE OF AGE GROUP 18-80 YEARS IN MAX SUPERSPECIALTY HOSPITAL, SAKET, NEW DELHI ” INDIA – A PROSPECTIVE STUDY -

Introduction: Chronic daily headache defined as headache occurring on 15 or more days in a month for at least three months affects around 4% of the general population causes significant distress with substantial impact on the quality of life of an individual and huge economic cost to the society through occupational disability and healthcare consultations. Objectives of the Study: To study the prevalence of chronic daily headaches in people of age group 18-80 years in Max Super Specialty Hospital and to identify risk factors associated with CDH (stressful life events, obesity, and medicine overuse.) Material and Methods: It was a prospective study conducted in Max Super Specialty Hospital, Saket, and New Delhi between Aug 2014 to May 2015. Patients coming with complaints of headache in age group of 18-80 yrs and fulfilling the inclusion criteria and exclusion criteria were enrolled in the study. Sample size was calculated by using n-Master (2.0) software and 176 subjects were enrolled. History of the patient including the precipitating factors and drug history was taken. MIDAS and HIT score was used to know the severity of headache; medical conditions were noted by taking brief interviews. Data was analyzed by using chi square test, Pearson’s correlation coefficient. Result: Of the 4500 subjects presented to our hospital with complaints of headache, 176 fulfilled the criteria of chronic daily headache (CDH) with a prevalence of about 4.5%. In our study we observed that 103 (58.5%) had migraine without aura, 30.6(20.5%) migraine with aura, 33(18.8%) tension type headache (TTH), 2 (1.1%) hemicranias continua and 2(1.1%) mixed-migraine and TTH.We observed that out of 176 patients in age group of 18-80 years ,maximum number of patients were in age group of 30-39 yrs- 67 patients(38.1%) and the least common age group was >70yrs where only 1 patient had chronic daily headache(CDH). It was observed that out of 176 patients 123 (69.9%) were females and 53 (30.1%) were males and type of headache was statistically significantly (p=0.00) associated with gender. Conclusion: We conclude that Migraine without aura was the most common type (58.5%) and least common type being mixed chronic migraine and tension type headache and Hemicrania continua 1.1%. We found chronic daily headache was more prevalent in females as compared to males, 123 (69.9%) were females and 53 (30.1%) were males. The most common age group affected was 30-39 years and was more common in married. We observed that most of the patients (61.9%) had BMI between 18.5 and 25.After analyzing risk factors it was observed that history of drug intake was present in 154 subjects, most common being Acetaminophen, Naproxen, Triptans, Ergotamine the rest were using preventive. In our study prevalence of medication overuse headache (MOH) among 176 patients of chronic daily headache is (108/176) 61.36% whereas prevalence of MOH in subjects coming to our hospital with headache is 2.4% (108/4500). Stress was the most common precipitating factor of chronic daily headache (CDH), stress was present in 146 patients (85.9%) others being lack of sleep, hunger, working on computer, noise, menstruation, sunlight, travel. Recommendations: Chronic daily headache is under estimated due to lack of awareness; screening of patients should be done on primary and secondary care centers to estimate the actual burden of disease. Stress, anxiety should be handled as early as possible to prevent transformation of episodic headache to chronic daily headache.