ORIGINALNI NAUCNI RADOVI ORIGINAL STUDIES

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1 Med Preg12008; LXI (5-6): Novi Sad: maj-juni. 215 'WI ORIGINALNI NAUCNI RADOVI ORIGINAL STUDIES Klinicki centar Vojvodine, Novi Sad Institut za neurologiju Originalni naucni rad Original study UDK :613 DOl: 1O.2298/MPNS S ISPITIVANJE KVALITETA ZIVOTA OBOLELIH OD TENZIONOG TIPA GLAVOBOLJE QUALITY OF LIFE RESEARCHIN PATIENTS SUFFERING FROM TENSION TYPE HEADACHE Svetlana SIMIC, Petar SLANKAMENAC, Aleksandar KOPITOVIC, Zita JOVIN i Sofija BANIC-HORVAT Sazetak - Tenzioni tip glavobolje je najucestalija glavobolja, pogada mnoge zene i rnuskarce u nekom periodu njihovog zivota i pogorsava poslovnu produktivnost, porodicno i drustveno funkcionisanje. Procenom kvaliteta zivota obolelih od tenzionog tipa glavobolje mozerno bolje da sagledamo uticaj bolesti na obolelog. U nasem istrazivanju izvrseno je poredenje kvaliteta zivota grupe obolelih od tenzionog tipa glavobolje i kontrolne grupe zdravih, primenom specificnog upitnika (Kvalitet zivota i migrena). Tokom istrazivanja dobijeni rezultati pokazali su da postoji znacajna razlika u kvalitetu zivota izmedu ispitivanih grupa, po svim subdomenima kvaliteta zivota na stetu obolelih od tenzionog tipa glavobolje. Kljucne reei: Kvalitet zivota; Tenzioni tip glavobolje; Upitnici Summary - The tension type headache is the most common headache type, which many men and women suffer from in one period of their life and aggravates business productivity, family and social functioning. Quality of life estimation in patients suffering from tension type headache enables us to get a better insight into the impact of the disease on the patient. The comparison among the quality oflife in the patients sufferingfrom tension type headache and the quality ofhie in the control group subjects has been carried out in a research by applying the QVM questionnaire. The obtained results have shown a significant difference in the quality of life and its sub domains indicating worse quality in the patients suffering from tension type headache. Key words: Quality oflife; -Type Headache; Questionnaires Uvod Tenzioni tip glavobolje je nespecificna glavobo Ija, koja nije vaskularno uzrokovana niti je udruzena sa organskim bolestima [1]. glavobolja je najucestalija glavobolja, pogada mnoge zene i muskarce u nekom periodu njihovog zivota i pogorsava poslovnu produktivnost i porodicno i drustveno funkcionisanje. Uprkos tome oboleli su cesto neshvaceni. Zbog ove pogresne percepcije mnogi pogodeni pacijenti nerado zatraze medicinsku pomoe [2]. Cifra prevalencije varira % sto je delom uslovljeno u razlikama u dizajniranju studija [3], 5% zena i 2% muskaraca opste populacije ima hronicnu tenzionu glavobolju, sa preko 180 dana sa glavoboljom tokom godine. Do 88% zen a i 69% muskaraca iskuse tenzioni tip glavobolje tokom svog zivota, Tokom detinjstva nema polne razlike u prevalenciji tenzione glavobolje. Kod odraslih je vise obolelih zena sa odnosom 5:4. Prevalencija hronicne tenzione glavobolje raste sa godinama, nasuprot tome prevalencija epizodicne tenzione glavobolje sa godinama opada. Introduction type headache is an unspecific headache, which has neither been caused by vascular system nor associated with organic diseases [1]. type headache is the most common headache type, which many men and women suffer from in one period of their life and aggravates business productivity, family and social functioning. Despite this, patients are frequently misunderstood. Due to this wrong perception, many affected patients are reluctant to ask for medical help [2]. The prevalence varies from 29 to 71%, which is limited mostly by the difference in study design [3], 5% of women and 7% of men suffer from the chronic tension headache, which is present for more than 180 days in a year. Up to 88% of women and 69% of men suffer from tension type headache in their life. During childhood there are no sex differences in the prevalence of tension headache. As for the adults, there are more female patients, the relation being 5:4. The prevalence of chronic tension headache increases with age, while the prevalence of episodic tension headache declines with age. Adresa autora: Mr sc. med. Svetlana Simic, 1nsitut za neurologiju, Novi Sad, Hajduk Veljkova 1-9, dsmic@(.unet.yu

2 216 Simic S, i sar. Ispitivanje kvaliteta zivota Skracenice QVM - Kvalitet zivota i migrena GI - globalni indeks PI - psiholoski indeks FI - funkcionalni indeks SI - drustveni indeks MI - medicinski indeks SF - kratka forma t - t vrednost p - p vrednost Subjektivna priroda glavobolje i odsutnost objektivnog klinickog pokazatelja tezine bolesti ostav Ija klinicara bez objektivnog standarda po kome bi sudio 0 uticaju glavobolje na pacijenta. lako primarne glavobolje nisu zivotno ugrozavajuce, mogu biti znacajan zdravstveni i socijalni problem. Poslednja dekada pokazuje rastuci interes za uticaj glavobolje na zivot pacijenta. Savremena medicina pored razvoja sofisticirane tehnologije treba da razvija i merne instrumente koji ce sveobuhvatno da ukazu na stanje zdravlja u vezi sa bolescu, Objektivizacija lekara nije dovoljan parametar da bi se utvrdio stvarni uticaj bolesti na pacijenta. Bitna je i subjektivna percepcija stanja, licni dozivljaj zdravlja i tretmana da bi se kao rezultanta dobio kvalitet zivota [4,5]. Tokom poslednje dekade medicinskim istrazivanjima razvijene su merne skale za mnoge bolesti [6]. Kvalitet zivota moze da se definise i kao harmonicni odnos stalnih promena zivotnih uslova i okolnosti da bi se uskladila cetiri osnovna zahteva za stabilnoscu i to fizickom, emotivnom, mentalnom i duhovnom. Krajnje pojednostavljena, ali u svakodnevnom zivotu primenljiva je definicija da je kvalitet zivota sveukupno uzivanje u njemu [7]. Postoji sest glavnih karakteristika kvaliteta zivota (Shema 1) [8]: 1. Subjektivnost - kvalitet zivota je subjektivan, sto podrazumeva da je individua jedini pouzdan izvor za evaluaciju kvaliteta zivota pojedinca. Dokazano je odstupanje (u pozitivnom i negativnom smeru) kvaliteta zivota pri prikupljanju podataka od porodice iii starateija, a takode i od zdravstvenih radnika, u odnosu na rezultate dobijene od samog pacijenta (najboljije self-report questionnaires). 2. Jedinstvenost - odslikava stanje kvaliteta zivota bez sacinjavanja zakljucaka 0 uzrocima iii opisivanja prethodne situacije. 3. Multidimenzionalnost - podrazumeva procenu kvaliteta zivota skorovanjem vise razlicitih oblasti zivota (npr. fizicko stanje, psihicko stanje, socijalno funkcionisanje, nivo samostalnosti, finansijska dimenzija, emocionalno stanje, porodicno funkcionisanje, seksualnost i dr.) Razvijene su kompjutenzovane metode za procenu multidirnenzionalnog uticaja bola na pojedinca [9].. 4. Mogucnost evaluacije - mogucnost pracenja tokom vremena. Abbreviations QVM - the Quality of Life and Migraine GI - global index PI - psychological index FI - functional index SI - social index MI - medical index SF - Short form t - t value p - p value The subjective nature of the headache and the absence of an objective clinical indicator of disease intensity leave clinicians without an objective standard, according to which they could judge the headache influence on patients. Although primary headaches are not life threatening, they can be a significant health and social problem. The last decade shows an increasing interest in headache influence on patients' lives. Besides the development of sophisticated technology, contemporary medicine should develop measurement instruments which would altogether indicate the state of health regarding the disease. The doctors' objectivity is not a sufficient parameter for determining the real influence of disease on patients. The subjective perception ofthe state is also important, as well as personal understanding of health and treatment in order to get the quality of life [4,5] as a result. Over the last decade, measurement scales for many diseases have been developed through medical research [6]. Quality of life could be defined as a harmonious relation ofthe constant change in life conditions and circumstances in order to match the following four stability demands physical, emotional, mental and spiritual. The definition of the quality of life as an overall enjoyment can be taken as ultimately simplified, but commonly used one [7]. There are six main characteristics of the quality of life (Sheme 1) [8): 1. Subjectivity - quality of life is subjective, which means that an individual is the only reliable an source for assessing the quality of life of individuals. The aberration in quality of life, during data gathering from families or guardians, as well as from medical workers, has been proven (in both positive and negative direction) in relation to the results received from the patients themselves (selfquestionnaire is the best). 2. Uniqueness - describes the state of quality of life without reaching the conclusion about causes and descriptions ofthe previous situation. 3. Multidimension - it means that the evaluation ofquality of life has to be done by gathering has different life areas, (e.g. physical state, psychic state, social functioning, the level of independence, financial di~ension, emotional state, family functioning, sexualtty and others). Computerised methods for evaluation ofmultidimensional influence of pain on an individual have been developed [9].

3 Med Preg12008; LXI (5-6): Novi Sad: maj-juni Dinamicnost - kvalitet zivota podrazumeva da je skor kvaliteta zivota osetljiv na promene pri promeni pacijentovog emocionalnog, fizickog, socijalnog iii drugih aspekta funkcionisanja. 6. Kvantitativnost - ukazuje na mogucnost pracenja i poredenja izrnedu individua, stanja i bolesti [8]. Standardizovanjem procene zdravstveno uslov Ijenog kvaliteta zivota omogucuje se kvantifikacija tezine bolesti [10,11]. Za procenu zdravstveno uslovljenog kvaliteta zivota mogu da se koriste: A. Opsti zdravstveni upitnici - poput Short Form: SF-8, SF-12, SF-20, SF-36 [12,13]; B. Za bolest specificni zdravstveni upitnici putem kojih se vrsi procena kvaliteta zivota obolelih od odredene bolesti. Zbog vaznosti njihovog sadrzaja za pac ijenta, specificni upitnici bolje odrazavaju stanje obolelog, imaju vecu validnost i pouzdanost za odredeno obo Ijenje, od opstih zdravstvenih upitnika. Upitnik "Kvalitet zivota i migrena" (QVM) je povoljan za poredenje kvaliteta zivota kod pacijenata sa migrenom i drugim formama epizodicne glavobolje ali i kod pacijenata sa hronicnorn dnevnom glavoboljom [14]. QVM upitnik se sastoji od :'0 pitanja koja su u vezi sa razlicitirn aspektima glavobolje: period ataka, kao i period van ataka, [acina bola, ucestalost, socijalno funkcionisanje, psihicko sianje, profesionalno funkcionisanje kao i porodicno funkcionisanje. Odgovori dobijeni na 20 pitanja se koriste za procenu [14,15]: - Globalnog indeksa, - Funkcionalnog indeksa, - Psiholoskog indeksa, - Drustvenog indeksa, - Medicinskog indeksa kvaliteta zivota. Materijal i metode Istrazivanje je sprovedeno na Institutu za neurologiju Klinickog centra u Novom Sadu, na uzorku od 60 ispitanika, oba pola, razlicite profesionalne orijentacije i starosti. Podela ispitivanog uzorka izvrsena je na sledeci nacin: - Eksperimentalna grupa koja se sastoji od 30 ispitanika obolelih od tenzionog tipa glavobolje. - grupa koja se sastoji od 30 zdravih ispitanika. Studija je sprovedena prospektivno, a od ispitanika su trazeni i retrospektivni podaci od znacaja za istrazivanje. Kriterijumi za iskljucivanje iz studije bili su nekooperativnost i ispitanici za koje se utvrdilo da boluju od neke druge bolesti koja bitno narusava kvalitet zivota, nezavisno od glavobolje. Kao instrument istrazivanja koriscen je QVM upitnik. Rezultati Prin~e~on~ QVM upitnika dobijeni su podaci koji su analizirani po pet osnovnih subdomena: globalni 4. The possibility of evaluation - the possibility of keeping record during time. 5. Dynamic - quality of life means that its result is sensitive to the changes during the changes in patients' emotional, physical, social and other aspects of functioning. 6. Quantity - indicates the possibility of making observation and comparison among individuals, states and diseases [8]. Quantification of disease severity is enabled by health conditioned quality of life evaluation standardisation [10,11]. For evaluation of quality of life influenced by health the following can be used: A. General health questionnaires - like Short Form: SF-8, SF-12, SF-20, SF-36 [12,13] B. Specific disease health questionnaires - according to which the quality of life evaluation of patients suffering from specific disease can be made. The specific questionnaires reflect better patients' state, ha,:e stro.nger validity and reliability regarding the specific disease than overall health questionnaires because of the importance of its content for patients. QVM questionnaire is suitable for comparison of quality of life in patients with migraine and other forms of episodic headaches as well as in patients with chronic daily headache [14]. QVM contains 20 questions regarding different aspects of headache: the period related to attacks, as well as the period beyond attacks, intensity of pain, frequency and social functioning, psychic state, professional as well as family functioning. Answers to 20 questions are used for the evaluation of[14, 15]: - Global index, - Functional index, - Psychological index, - Social index, - Medical index of quality of life. Material and methods The research was carried out at the Institute of Neurology, Clinical Center Novi Sad, on 60 subjects of both sexes, with different professional orientation and age. The division of the sample was accomplished as follows: - Experimental group consisting of 30 patients who suffer from tension type headache. - group consisting of 30 healthy subjects. The study was carried out prospectively, while the retrospective data significant for research were requested from the subjects. The criteria for excluding from the study were uncooperation and subjects founj to suffer from some other disease significantly impairing quality of life, other than headache. QVl\1 questionnaire was used as a research instrument.

4 218 Simu: S, i sar. Ispitivanje kvaliteta zivota &lbjektivnosl ~ KVALITET ZIVOTA KVd~ Slika 1. Karakteristike kvaliteta zivota Picture 1. Life quality characteristics I ~val"a"j' Dinarnicnost indeks (01), psiholoski indeks (PI), funkcionalni indeks (FI), drustveni indeks (SI) i medicinski indeks (MI). Svaki od subdomena je nadalje rangiran na tri nivoa: nizak (GI-I, PI-I, FI-I, SI-I, MI-I), srednji (01-2, PI-2, FI-2, SI-2, MI-2) i visok (GI-3, PI-3, FI-3, SI-3, MI-3). Tokom istrazivanja dobijeni rezultati pokazali su da postoji znacajna razlika u kvalitetu zivota izmedu ispitivanih grupa obolelih od tenzionog tipa glavobolje i kontrolne grupe zdravih. U kontrolnoj grupi zdravih ispitanika je nivo visok najzastupljeniji u svim subdomenima kvaliteta zivota. Kod funkciona/nog i medicinskog indeksa kvaliteta zivota nivo visok zastupljen je kod 100% ispitanika, za g/oba/ni i psiholoski indeks kvaliteta zivota kod 96,7% ispitanika a za drustveni indeks kvaliteta zivota kod 90% ispitanika. U grupi obolelih od tenzionog tipa glavobolje (Tabela 1) nivo visok najzastupljeniji je jedino kod medicinskog indeksa (73,3%) kvaliteta zivota, alije i tada nizi od medicinskog indeksa kontrolne grupe. Nivo srednji kod obolelih od tenzionog tipa glavobolje najzastupljeniji je za g/oba/ni i funkciona/ni indeks kvaliteta zivota, a nivo nizak najzastupljeniji je za drustveni indeks kvaliteta zivota. Tabela 1. Brojcana (n) i procentualna (%) zastupljenost pojedinih nivoa svakog od subdomena kvaliteta zivota QVM upitnika, kod obolelih od tenzionog tipa glavobolje Table 1. The presence ofcertain levels ofeach subdomain of QVM life quality questionnaire ofpatients suffering from tension type hedache. shown in numbers (n) and percentage (%) GI PI FI SI MI n % n % n % n % n % /Low 6 20 II 36, , /Medium 16 53, , ,67 2 6,67 /High 8 26,67 II 36, , , ,33 Primenom t-testa utvrdena je statisticki znaeajna razlika u kvalitetu zivota izmedu obolelih od tenzionog tipa glavobolje i ispitanika kontrolne grupe za pojedine nivoe svakog od subdomena kvaliteta zivota 8toje prikazano u tabelama 3 i 4. Results The data analysed through five basic sub domains have been obtained by applying QVM questionnaire: global index, psychological index, functional index, social index and medical index. Each sub domain has been further ranged on three levels: low (GI-I, PI-I, FI-I, SI-l, MI-I), medium (GI-2, PI-2, FI-2, SI-2, MI-2) and high (GI-3, PI-3, FI-3, SI-3, MI-3). The obtained results have shown a significant difference in the quality oflife in the patients suffering from tension type headache and control group of healthy subjects. In the control group of healthy subjects a high quality of life index prevails in all its sub domains. The high level of medical and functional quality of life index is present in 100% of subjects, and global and psychological quality of life index is present in 96.7% of subjects, social quality of life index present in 90% of subjects. In patients suffering from tension type headache, a high level is most present only in the medical index (73.3%) of the quality of life, although it is still lower from the control group medical index. A medium level in the patients suffering from tension type headache is most present in the global and functional index ofquality oflife. Low level is most present in the social index ofquality oflife. A statistically significant difference in quality of life in the patients suffering from tension type headache and subjects of control group at some level of each life quality sub domain has been determined by applying the t-test, as shown in tables 3 and 4. Tabela 2. Brojcana (n) i procentualna (%) zastupljenost pojedinih nivoa globalnog indeksa (GI) kvaliteta zivota po ispitivanim grupama Table 2. The presence ofcertain global index levels (GI) of the quality oflife according to the studied groups, shown in numbers (n) and percentage (%) 01-1 GI-2 Gr-3 n % n % n % / o 0 1 3, ,7 Tenzions/ ,3 5 26,7 100~ O.j&l1llll-- m1.. - III kontrolna 0 tenziona G~2 r-.l-3 Gratikon 1. Zastupljenost procene pojedinih nivoa globalnog indeksa (GI) kvalitcta zivota po ispitivanim grupama Graph 1. The presence of assessment of certain global index (GI) life quality levels according to the studied groups

5 Med Pregl 2008; LXI (5-6): Novi Sad: maj-juni. 219 Tabela 3. Znacajnost razlike izmedu grupa ispitanika u odnosu na procenu kvaliteta zivota putem globalnog (GI), i psiholoskog indeksa (PI) koriscenjern t-testa Table 3: The difference importance among questioned groups In relation to assessment the quality oflife by global (GJ) and psychological index (PI) using the t-test Grupe/Cirollps Proporcija % Grupa J Grupu 2 Group J Group 2 Con/rot Tenzicna Tens/on Diskusija Nivo!,owGJ MedillmGj HiKhGI row})! Medium l'i "'KhPf Proportion mlini m2/n2 prop prop2 0/30 6/ ,58 0,012 1/30 16/30 3,33 53,33-4,30 0,000 29/ ,67 26,67 5,58 0,000 0/30 11/30 36,67-3,67 0,001 1/30 8/30 3,33 26,67-2,53 0,014 29/30 11/30 96,67 36,67 4,93 0,000 Obo}eli. 0vd tenzionog tipa glavobolje cesto su ne~hvacel1l, cak I od.ie~~ra, k?ji moze da trivijalizuje problem;, sm.a~rajucl ~a simptomatska terapija prl.s~re~u,!no~e biti dovoljna, Stres je najcesci pre Clplt.lraJucl.Inger faktor u preko 80% obolelih od tenzionog tipa glavobolje. Mentalni stres rnoze da izazove.misicnu kontrakciju. Povecana prevalencija k?morbldne, a.nksloznosti, depresije i somatoform I1Ih pore~e.c1l)a med,u obolelima od tenzionog tipa ~IavoboljeJOs uvek Je predmet rasprave. Studijama Je pokazano da.uporedujuci sa.kontrolnom grupom p~~ijentl ~bolell od ten~lonog trpa glavobolje imaju sli~~le. velike. st.res~e zlvo~ne dogadaje ali ih teze dozivljavaju I imaju manje efektivne mehanizme odbrane. Zbog visoke prevalencije i sirokog spektra nesposobnosti, migrena i tenzioni tip glavobolja imaju velik.1 socloeko.nomski znacaj. Poslednja dekada pokazuje.rastucl mteres za posledice migrene i tenzionog. ttpa glav?b.olje na zivot pacijenta [16], te su razvijeru rnerrn instrurnenti za procenu zdravljem uslovljenog kvaliteta zivota. U,nasem istrazivanju primenom QVM upitnika ~alazlmo da j~ kv~i.i.~et zivo~a obolelih od tenzionog tipa glavobolje 10SlJI po svirn subdomenima kvaliteta ziv?ta?d.~ontrolne grupe, sto je u skladu sa rezultatima IS~ltlvaca koji su slicna ispitivanja radili na mnogo vecem uzorku. Solomon i saradnici na uzorku od ~08 pacijenata ukazuju da je kvalitet zivo~~ odraslih sa hronicnorn glavoboljom znacajno snizen. Globalni indeks kvaliteta zivota koji se racuna na o~novu ~vlh postavljenih pitanja, kod obolelih od tenzronog trpa glavobolje znacajno je losiji od kontro,ine grupe. I?ur~ i ~aradnici su u st~diji sprovedenoj na I 486 ispitanika (880 obolelih od migrene, Tabela 4. Znacajnost razlike izmedu grupa ispitanika U odnosu na proccnu kvaliteta zivota putern funkcionalnog (FI), drustvenog (SI) i medicinskog indeksa (MI) koriscenjem t-testa Table 4. The difference importance among studied groups in relation to assessment ofquality oflife by functional (FJ), social (SI) and medical index (MI) using the t-test Grupe/Gl'Oups Proporcija % Grupu I Gmpa 2 Group j Group 2 (:onlrol Tenzions Discussion Nivo I,eve! Low 1'1 MediumFI HiKhN lowsl MedtnmSl HiKhSf Proportion In 1/nI m2/n2 propi prop2 0/30 5/ /30 0/30 9/30 16,67-2,34 0, ,07 0,000 30/30 7/ ,33 6, II 0, ,25 0,002 3/30 12/ ,68 0,009 27/30 9/ ,74 0,000 The patients suffering from tension type headache are usually mis.u1~d~rstood, even by doctors who can sometimes trivialise the problem, believing t~at the symptom therapy during stress can be sufficrent. Stre~s IS ~he most.common precipitating trigger factor m 80Ya of patients suffering from tension type headache. Mental stress can cause the muscle con~raction, The!ncreased prevalence of comorbid anxiety, depression and somatoform disorders among th~ patients suffering fr.om t~nsion type headache IS still the subject of discussion. Studies have shown that in comparison to the control group, p~tl~nts suffenng. from tension type headache have similar stressful life experiences but do not tolerate them well and have less effective defence mechanisms. ~igraine and tension type headache are of great socio-economrc significance because of the high prevalence and wide spectrum of ineptness. The last decade has shown a growing interest in the consequ~nces, or migraine and tension type headache in patients lives [16], therefore measurement instruments for evaluation ofquality oflife influenced by health have ~een developed. By a.pplymg QVJYl questionnaire during our research,. It has bee~ discovered that quality of life in the patients suffering from tension type headache it all its sub domains is worse than in the control group, which is in accordance with results of researchers who carried out the similar research on larger scales. Solomon and his co-workers have shown that. the quality of l,ife. of adults suffering from chronic headache IS significantly lowered ill 208 patients. Global quality of lire!ndex, determined by ans,wermg que~tlons, IS significantly worse in the patients suffenng from tension type headache than in

6 220 Simic S, i sar. Ispitivanje kvaliteta zivota 151 oboleli od hronicne dnevne glavobolje i 455 sa epizodicnom glavoboljom) utvrdili da je globalni indeks kvaliteta zivota nizi kod obolelih od migrene u odnosu na obolele od drugih epizcdicnih glavobolja, a najnizi je kod obolelih od hronicne dnevne glavobolje. Psiholoski indeks, koji se racuna na osnovu odgovora na pitanja koja su u vezi sa brigom zbog glavobolje, osecaj neshvacenosti, osecaj razlicitosti, tugu, nervozu, umor i nedostatak energije, znacajno je losiji kod obolelih od tenzionog tipa glavobolje. Migrena i tenzioni tip glavobolje imaju negativan uticaj na emocionalni zivot obolelih sto u svojim istrazivanj ima, na uzorku od 394 ispitanika, isticu Nodari i saradnici istrazivanjem na mladoj italijanskoj populaciji oboleloj od primarne glavobolje [2,6,16]. Funkcionalni indeks koji se racuna na osnovu odgovora dobijen ih na pitanja koja su u vezi sa jacinom bola, dugotrajnoscu i ucestaloscu ataka, pratecim tegobama, promenama zivotnog stila, seksualnim zivotom obolelog, snom, ishranom, znacajno je losiji kod obolelih od tenzionog tipa glavobolje u odnosu na kontrolnu grupu, ali je bolji od funkcionalnog indeksa obolelih od migrene, sto je u skladu sa cinjenicom da tenzioni tip glavobolje nije udruzen sa migreni slicnim simptomima poput muke, povracanja, fotofobije, fonofobije, pojacavanja bola sa fizickorn aktivnoscu [2,17]. Medicinski indeks QVM upitnika racuna se na osnovu odgovora na pitanja u vezi sa posetama lekaru i lecenjem, pri cernu je indeks visok ukoliko paeijent ne mora da pije lekove i da se konsultuje sa lekarom. Od svih subdomena kvaliteta zivota medieinski je najvisi, sto je u skjadu sa cinjenicom da manje od 15% obolelih od tenzionog tipa glavobolje trazi medicinsku pornoc [2]. Drustveni indeks koji se racuna na osnovu odgovora na pitanja u vezi sa poslom, svakodnevne aktivnosti, odnos sa porodicom i slobodne aktivnosti znacajno je nizi kod obolelih od tenzionog tipa glavobolje. Migrena i tenzioni tip glavobolje veoma su cesti medu zaposlenima i imaju znacajan efekat na ekonomsku produktivnost i socijalno funkcionisanje. Redukcija produktivnosti onih koji i pored glavobolje rade je takode velika. Solomon i saradnici primenom SF-36 upitnika nalaze da je kod obojelih od tenzionog tipa glavobolje nizi socijalni skor funkcionisanja od migrenoznih pacijenata i obolelih od klaster glavobolje. Zakljucak S obzirom na veliku ucestalost obolelih od tenzionog tipa glavobolje, radi boljeg sagledavanja problema obolelih potrebno je izvrsiti procenu a potom i pracenje kvaliteta zivota. Pracenjem kvaliteta zivota mogli bi da se prate terapijski efekti preduzetih mera. the control group. The study conducted by Duru and his co-workers on a sample of I 486 subjects (880 of them suffering from migraine, 151 with chronic daily headache and 455 with episodic headache) has shown that global quality of life index is lower in patients suffering from migraine than in patients suffering from other episodic headaches, the lowest being in patients suffering from chronic daily headache. Psychological index, which is determined by answering the questions relating to the concern about the headache, the sense of being misunderstood, being different, sadness, nervousness.tatigue and lack of energy, has been significantly lower in patients suffering from tension type headache. Migraine and tension type headache have negative influence on the emotional life of patients, as it has been observed by Nadari and his co-workers who carried out a research on a sample of 394 young Italian people with primary headache [2,6,16]. Functional index, which is determined by answering the questions about pain intensity, attack length and frequency, life style change, sexual life of patient, sleep, food, is significantly worse in patients suffering from tension type headache than in control group subjects, but it is better than the functional index 111 patients suffering from migraine. This is in accordance with the fact that tension type headache is not associated with the migraine-like symptoms such as nausea, vomitting, photophobia, phonophobia, intensification of pain during physical activity [2,17]. Medical index of QVM questionnaire is determined by answering questions relating to visiting doctors and treatments, the index being hish if the patient does not have to take medicine andconsult doctors. Of all quality of life sub domains, the medical one is the highest, which is in accordance with the fact that less than 15% of patients SUffering from tension type headache ask for medical help [2]. Social index, which is determined by answering questions about work, every day activities, relationship with family and free time activities, is significantly lower in patients suffering from tension type headache. Migraine and tension type headache are frequent among employees and have significant effect on economic productivity and social functioning. The reduction of productivity of those who suffer from headache but still work, is also high. By applying SF-36 questionnare Solomon and his coworkers have found that the patients suffering from tension type headache have lower social score of functioning than the patients sufering the patients suffering from migraine and from cluster headache. Conclusion Regarding the high frequency of patients suffering from tension type headache, it IS necessary to make estimation and follow quality of life for better problem understanding. Therapeutic effects of used measures can be followed by observing the quality of life.

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