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. 2017 Dec 15;7(12):e019929.
doi: 10.1136/bmjopen-2017-019929.

The lived experience of chronic headache: a systematic review and synthesis of the qualitative literature

Vivien P Nichols  1 , David R Ellard  1 , Frances E Griffiths  2 , Atiya Kamal  1 , Martin Underwood  1 , Stephanie J C Taylor  3 ; CHESS team
Collaborators, Affiliations

The lived experience of chronic headache: a systematic review and synthesis of the qualitative literature

Vivien P Nichols et al. BMJ Open. .

Abstract

Objective: To systematically review the qualitative literature of the lived experience of people with a chronic headache disorder.

Background: Chronic headaches affect 3%-4% of the population. The most common chronic headache disorders are chronic migraine, chronic tension-type headache and medication overuse headache. We present a systematic review and meta-ethnographic synthesis of the lived experience of people with chronic headache.

Methods: We searched seven electronic databases, hand-searched nine journals and used a modified Critical Appraisal Skills Programme checklist to appraise study quality. Following thematic analysis we synthesised the data using a meta-ethnographic approach.

Results: We identified 3586 unique citations; full texts were examined for 86 studies and 4 were included in the review. Included studies differed in their foci: exploring, patient-centred outcomes, chronic headache as a socially invisible disease, psychological processes mediating impaired quality of life, and the process of medication overuse. Initial thematic analysis and subsequent synthesis gave three overarching themes: 'headache as a driver of behaviour' (directly and indirectly), 'the spectre of headache' and 'strained relationships'.

Conclusion: This meta-synthesis of published qualitative evidence demonstrates that chronic headaches have a profound effect on people's lives, showing similarities with other pain conditions. There were insufficient data to explore the similarities and differences between different chronic headache disorders.

Keywords: chronic migraine; chronic tension type headache; medication overuse; patient views; qualitative research.

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Conflict of interest statement

Competing interests: MU and ST report grant from National Institute for Health Research. MU reports personal fees from National Institute for Health and Care Excellence, grants from Arthritis Research UK, personal fees from National Institute for Health Research, outside the submitted work, and was Chair of the guideline development group that produced the 2012 NICE headache guidelines. The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.
Figure 2
Figure 2
Third-level conceptual framework.
See this image and copyright information in PMC

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