Clinical Spectrum of Primary Headache Disorders at a Tertiary-Care Hospital in Eastern India: A Prospective Observational Study

Spectrum of primary headache disorders

Abstract

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Background: Primary headache disorders are leading contributors to disability worldwide, but prospective regional data from Eastern India remain limited. Our objective was to describe the sociodemographic profile, clinical characteristics, triggers, disability, and treatment patterns; and to explore factors associated with moderate to severe disability.
Methods: A Prospective, observational study was conducted in a tertiary-care teaching hospital over 12 months. Consecutive adults (18–65 years) meeting International Classification of Headache Disorders, 3rd Edition primary-headache criteria were included, and patients who refused to give consent were excluded. Case-record form captured demographics, phenotype, monthly headache days (MHDs), intensity (visual analogue scale), triggers, and disability (Migraine Disability Assessment [MIDAS]/Headache Impact Test-6 [HIT-6]). Analyses included descriptive summaries, group comparisons, and multivariable logistic regression for predictors of moderate-severe disability (MIDAS III-IV).
Results: We enrolled 420 adults, of whom 286 (68.1%) were female; the mean age was 33 ± 11 years. The phenotype distribution was migraine in 269 (64.0%) – including 210 without aura, 59 with aura, and 32 chronic – tension-type headache in 134 (31.9%) – 110 episodic and 24 chronic – and cluster headache in 17 (4.0%). Common features included unilateral pain in 298 (71.0%), throbbing quality in 290 (69.0%), nausea/vomiting in 244 (58.1%), photophobia in 260 (61.9%), phonophobia in 239 (56.9%), and aura in 59 (14.0%). Frequently reported triggers were stress 260 (62.0%), sleep loss 206 (49.0%), fasting 130 (31.0%), menstruation 132/286 (46.2% of women), weather change 118 (28.1%), caffeine withdrawal 67 (16.0%), and screen exposure 155 (36.9%). Disability was substantial with MIDAS 12 (IQR 6–25), Grade III–IV in 193 (46.0%), and HIT-6 severe in 172 (41.0%), while medication-overuse headache affected 50 (12.0%). In multivariable analysis, higher MHDs (adjusted odds ratio 1.45 per 5-day increase), medication overuse (2.10), anxiety/depression (1.82), and female sex (1.39) independently predicted moderate–severe disability, all P ≤ 0.045.
Conclusions: Migraine predominated and conferred substantial disability. Addressing modifiable triggers and MOH, routine disability screening, and timely preventive therapy may reduce burden.