ORIGINAL ARTICLE

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A COMPARISON OF HEADACHE AND NON-HEADACHE SUFFERERS ON MEASURES OF SOCIAL SUPPORT AND MENTAL HEALTH PROBLEMS

Table 1. Socio-demographic characteristics of respondents

Characteristics	Headache, n (%)	No headache, n (%)
Age groups (years)
<20	46 (33.3)	48 (34.8)
21-30	72 (56.2)	72 (56.2)
31-40	10 (7.2)	7 (5.1)
41-50	5 (3.6)	5 (3.6)
>50	5 (3.6)	6 (4.3)
Ethnic groups
Malay	5 (3.6)	4 (2.9)
Chinese	91 (65.9)	90 (65.2)
Indian	31 (22.5)	30 (21.7)
Others	11 (8.0)	14 (10.1)
Total	138	138

Table 2. Comparison of mental health and social support by headache status

Characteristics	Headache, mean (SD)	No headache, mean (SD)
Mental Health	23.37 (5.20)	24.91 (6.46)*
Social Support – Family	1.81 (0.41)	2.06 (0.61)*
Social Support – Friend	2.05 (0.49)	2.11 (0.56)
Social Support – Significant others	2.06 (0.58)	2.12 (0.60)

* p <0.01

In this case, it would appear that subjects with headaches, as compared with subjects without headaches, reported that they feel incapable of making decisions about things [t (274) = -2.311, p < .01], they were not able to face up to their problems [t (274) = 0.426, p < .01], and think about themselves as a worthless people [t (274) = 0.221, p < .01].

To find out the significant differences in social support among headache and non-headache subjects, Hotelling’s T2 was also carried out (see Table 3).  Higher scores are indicative of better social support. In this case, it appeared that headache sufferers received more social support from family as compared with non-headache sufferers [t (274) = -3.762, p < .01]. However, there were no significant differences for social support from friends [t (274) = -.740, p > .01], and significant others [t (274) = -.690, p > .01].

Table 3. Mental health question items by headache status

Item	Mental Health Question	No Headache	Headache	T value
c1.	Not been able to concentrate on whatever you’re doing?	2.04	2.13	-1.06
c2.	Lost much sleep over worry?	2.14	2.11	0.27
c3.	Felt that you are not playing a useful part in things?	1.97	2.07	-1.25
c4.	Felt in capable of making decisions about things.	1.83	2.03	-2.31*
c5.	Felt constantly under strain?	2.31	2.27	0.43
c6.	Felt you couldn’t overcome your difficulties?	2.04	2.16	-1.10
c7.	Not been able to enjoy your normal day-to-day activities?	1.96	2.10	-1.73
c8.	Not been able to face up to your problems?	1.94	2.28	-4.0**
c9.	Been feeling unhappy and depressed?	2.01	1.99	0.22
c10.	Been losing confidence in yourself?	1.80	1.99	-1.79
c11.	Been thinking about yourself as a worthless person?	1.55	1.88	-3.31**
c12.	Not been feeling reasonably happy, all things considered?	1.95	2.02	-0.93

* p <0.05
** p <0.01

DISCUSSION

This study was set up to find out if there were differences between a community sample of headache and non-headache sufferers in terms of their mental health and social support levels. The results of this study indicated that headache sufferers, as compared with non-headache sufferers, generally had slightly more mental health problems, and more social support from their family members.

The finding that headache sufferers have slightly more mental health problems, as compared with non headache sufferers, has a similar trend when compared with other studies.  However differences in intensity of the mental health problems are minimal.  This may be because a community, rather than a clinical sample was studied and the level with which subjects would have been able to cope with their headaches would perhaps be higher than in a clinic sample. Given this situation, the community sample of headache sufferers may perhaps be less anxious and agitated about their headache pain, as compared with those from a clinic sample.

It was observed that headache sufferers tended to have higher levels of social support from their family members, as compared with non-headache sufferers.  This finding is similar to that of other studies which generally have observed higher social support levels amongst headache sufferers.¹¹ When a person has a headache, there is a natural tendency for others to want to assist them. Given that 71.4% of subjects in this study fall within the age range of students, it would be normal that many are still living with their families. Thus, when they get ill, their family members, usually their parents, would provide care and assistance to them.

When an item-by-item analysis on mental health questions was carried out, it appeared that subjects with headaches, as compared with subjects without headaches, report significantly more problems on some specific mental health items. The subjects with headaches felt more incapable of making decisions about things, were not able to face up to their problems, and thought about themselves as a worthless people. All these three symptoms are problems of negative thoughts and coping suggesting some degree of depressive symptomatology, according to the DSM IV.¹² This would thus lead us to suggest that when it comes down to specifics issues, subjects with headaches may report greater depressive symptoms, as compared with subjects without headaches. In this context, the results are more similar to results of previous studies.7 Given this situation, future studies may need to use a more specific mental health tool which measures depression, rather than a general mental health.

There are a variety of factors which may contribute towards the limitations of this study. Firstly, no information was collected of how severe the headaches were. However, the intensity of pain of headaches is a subjective matter that varies from person to person.  In this study, the main information that we have is that the person suffers from headaches once every fortnight or twice monthly. 

A second limitation of this study concerns not knowing anything about associated medical conditions of the subjects, and also sampling them from one main age group. In this study, these questions have not been asked, and the sample does not control for these demographics. This may be an important consideration given that older people tend to be more susceptible to more chronic aches and pains, thus affecting their mental health levels. Future studies might want to group the sample into different age groups, and also include questions that enquire about the existence of other medical conditions.

Despite the limitations of this study, there are some useful insights that may be derived from this study. The mental health of headache sufferers may not differ much from non-headache sufferers. However, given their pain, they sometimes develop negative impressions of their ability to carry out their daily tasks. These are emotional behaviours that medical professionals who are treating headache sufferers need to be aware of, and be emphatic towards. Thus, we would need to be aware of specific mental health problems amongst headache sufferers.

In this study, it was observed that headache sufferers, as compared with non-headache sufferers, have slightly more general mental health problems, and higher levels of some specific problems indicative of depressive symptoms. The headache subjects, as compared with non-headache subjects also had higher levels of social support from their family members. The results need to be taken with some caution given that the sample used is a community, rather than a chronic sample, and does not control for differing age groups, or specify the type of headaches. To conclude, further research would be required that examines the types of headaches that people are suffering from, the intensity of the headaches, and specific mental health as compared with general mental health issues.

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