The SPI Online Test For Headache Pain, The Different Types And Causes Of Head Pain

WHAT IS THE SHORT PAIN INVENTORY (SPI©)?

The SPI© is an extremely well validated psychological pain test used in hospital clinical audit,  clinical trials of new analgesics and in pain clinics. It has been published in peer reviewed medical and scientific literature. It can measure whatever type of head pain you have. You can now do the headache pain test online, here today, right now.

We can tell you how much your headache pain is affecting you and how well you are coping. No matter what causes pain, there is usually a strong relationship between headache pain severity and mood. The more head pain you are in the more anxiety you will experience. The more pain the more sadness and anger. We have also found that concentration is impaired during headache pain and we feel less likely to be polite with a reduction in social interaction. Pain can make you tired. Severe head pain can make you very, very tired indeed. Mood is what we feel and can be composed of anger, anxiety, sadness, and other mood related items including social interaction and sedation or tiredness. High levels of mood disturbance indicate stress. The SPI© allows you to identify the emotional components of stress. We can add up all the component moods in our test to give you an overall mood disturbance score. The more head pain you have the more mood disturbance you will experience (see Graph 1). The main feature of migraine and headache is of course pain. Pain causes mood change and your mood, can in turn, affect the head pain you experience.

In a series of studies, we developed this specific psychological test that narrowed down about 300 questions to less than 20 items that were highly discriminating between subjects with and without pain. Moreover, we developed the SPI© test to discriminate between fine gradations of pain including mild, moderate severe and extreme pain. We carried out laboratory studies to induce tiredness with Benzodiazepines and calibrated the test against computerised psychometric tests. We carried out analgesic clinical trials and used the test to measure the efficacy of the test in randomised placebo controlled studies. We then looked at pain in various situations including elective surgery, dental patients and mixed groups in the chronic pain clinic. We compared the reliability and discriminability with other well established tests such as the McGill Pain Questionnaire (MPQ), The Headache Impact Test (HIT-Dyna®) and the Spielberger State-Trait Anxiety Inventory. We have used the SPI© test in primary care to examine head pain in patients such as tension type headache, chronic daily headache and migraineurs.

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Total mood disturbance scores increase with increasing head pain.

Graph1.

Graph showing head pain figures

Explanation of the graph is simple. On the bottom you have headache pain severity starting from no pain at all. Moving on from left to right there is a little bit of head pain or mild pain. Next up is moderate pain followed by still more pain called severe. Extreme head pain is difficult to bear for long. Put simply, the more painful the headache, the more mood disturbance we find. This graph is a simplified version of that published this year in International Journal of Pharmaceutical Medicine in which we studied headache patients in primary care. Extreme headache pain typically causes a total mood disturbance of about 7. A total mood score of 7 is a very unpleasant state to be in and this will have major effects upon relationships, work, study and play. The subtypes of mood often move in the same way - the more head pain the more mood.

With migraine, there is sometimes a build up of tiredness and mood change before the headache starts (the prodrome). In this sense, the mood change and stress can act as a trigger, precipitating a full blown headache. Headache can be triggered by a prodrome of stress or mood disturbance. Similarly, after a major headache has passed, there can be an postdromal period where the patient feels exhausted and irritable. The SPI© is a test that allows you to measure these effects in you, prior to a headache, during a headache and after a headache until recovery. Some forms of head pain referred to as Chronic Daily Headache (CDH), have patients who typically never recover. If you are unfortunate to be one of these patients, your friends, family and work colleagues probably have no idea how bad it is for you. Perhaps they might make some allowances for what is for many a considerable misery. For many, headaches produce a stress in itself, to be endured in silence. Our research has found that the mood disturbance in (CDH) is of the same magnitude of disturbance as that seen in UK pain clinics where resources are often more plentiful. The effects of headache can have considerable effects upon your relationships, your work and play. A study in Michigan USA revealed a clear association between migraine, anxiety, depression and suicide. Head pain can lead to job loss and school work suffering.

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Consequences of Migraine:

Only about 1 in 5 sufferers seek help from a doctor. In the USA direct medical costs related to migraine are estimated to be 1 billion US dollars/ year and the indirect costs due to lack of productivity are 13 billion US dollars. The UK costs are about a tenth of the US costs. The estimated cost to countries like the USA and UK is 0.5% of GDP.

There is a clear link between depression, suicide and migraine. An epidemiological (diseases in populations) study of young adults linking migraine to psychiatric disorder and suicide attempts [N Breslau et al. Migraine, psychiatric disorders, and suicide attempts: an epidemiological study of young adults. Psychiatry Research 1992 37: 11-23] is quite staggering.The study examined 1,007 young adults aged 21 to 30 years olds in Michigan USA. They participated in a structured interview which used the International Headache Society definitions of migraine and the National Institute of Mental Health diagnostic interview schedule to gather information on psychiatric disorders. The results showed a lifetime prevalence of migraine of 7% in men and 16% in women. There were higher lifetime rates of psychiatric disorders in persons with migraine. For instance, major depression occurred in 9% of people without migraine, but in 22% of people with migraine without aura and in 32% of people with migraine with aura. Panic occurred 10 times more frequently, at 17%, than in people without migraine. Anxiety occurred in 21% of people without migraine and 54% of people with migraine. Perhaps the most startling result, though, was that suicide attempts were very much higher in migraine sufferers, especially in those with aura.

When broken down according to the type of migraine and the presence and absence of major depression, the figures confirm this remarkable trend. For some people, migraine can be catastrophic.  Association between migraine, depression and suicide attempts

table showing Association
        between migraine, depression and suicide attempts

Clearly there is much more to migraine than expensive and effective new drugs, and a significant economic drag on the economy. The misery and suffering to the individual needs noticing.

Source: Dr Shaun Kilminster

Publication Date: July 2003

 

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