Prognostic factors for chronic headache – a systematic review Can we identify factors predicting prognosis and influencing response to preventive interventions for chronic headache?

Talk Code: 
Martin Underwood
Katrin Probyn, Hannah Bowers, Dipesh Mistry, Fiona Caldwell,Martin Underwood, Manjit Matharu, Tamar Pincus on behalf of the CHESS team
Author institutions: 
1. Department of Psychology, Royal Holloway, University of London, Egham Hill, Egham, Surrey, TW20 0EX, UK. 2. Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK. 3.Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG. UK


A wide range of demographic, clinical, psychological and social factors may affect prognosis and treatment outcome for people with chronic headache. Our aims were to identify predictors of prognosis and trial outcomes in prospective studies of people with chronic headache


A systematic review of published literature in peer-reviewed journals. We included a) randomised controlled trials (RCTs) of interventions for chronic headache that reported subgroup analyses and b) prospective cohort studies, published in English, since 1980. Participants included adults with chronic headache (including: chronic headache, chronic migraine, chronic tension-type headache with or without medication overuse headache respectively).

We searched key databases, two reviewers independently extracted data, assessed the methodological quality of studies and overall quality of evidence identified using appropriate published checklists



We identified 16556 titles, removed 663 duplicates, and reviewed 233 papers, of which 27 were included in the review - 17 prospective cohorts and 10 RCTs with subgroup analyses reported.

There was moderate quality evidence indicating that depression, anxiety, poor sleep and stress, medication overuse and self-efficacy for managing headaches are potential prognostic factors in chronic headache. There was inconclusive evidence about treatment expectations, age, age at onset, body mass index (BMI), employment and several headache features.



This review has identified several potential predictors of poor prognosis and worse outcome post interventions in people with chronic headache. The majority of these are modifiable. The findings also highlight the need for more longitudinal high quality research of prognostic factors in chronic headache

Submitted by: 
Katrin Probyn
Funding acknowledgement: 
This research was funded by the NIHR Programme Grants for Applied Research programme (RP-PG-1212-20018). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.