ABSTRACT

The available literature indicates that an appreciable part of what we

know about the social origin of migraine has not come necessarily from the
work focused on migraine. Researcher who are interested mainly in the
effect of social support and subjective well being on migraine do not have to
depend upon its spontaneous or natural occurrence in order to carry out their
studies. On the contrary research in to the biological and biochemical
functioning of the organism can be conducted more effectively when the
migraine is experimentally aroused and controlled in the laboratory. The
orientation has begun to change as a result of several conditions such as
greater awareness of the social epidemiology of ailments having a migraine
etiology; efforts to understand the consequences of disaster; concern with at
risk group in the society, studies of people in their community setting and
greater attention to the social influences underlying the mediators of stress,
migraine and social support every were we can see worried, unhappy, poor
subjective wellbeing and who are unable to utilize their best potentialities
because of their unsatisfactory adjustment to their environment. Instead of
smooth effective function we find wide spread symptoms of personality
maladjustment in many cases. The stress of modern life proves to much for
an individual to cope with and becomes a psychiatric of psychosomatic
causality.

The many researches show that relationship between social support

and mental health. Cottrell, Constance K. et al (2002) tried to identity the
area that people found most difficult in living with migraines, and in that
regard, what kinds of assistance would be most helpful to them and to other

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people who had migraine headaches. They conceptualized live themes,
impact on family, ii- misunderstanding by others, iii. effect en others, viz.
physician care issues and v. issues related to medical insurance and drug
companies. It is still not clear that which types of needs were responsible to
create symptoms of migraine headache.

Blomkvist V et al (2002) investigated similarities and differences

between patients with cluster headache and migraine patients in the
reference of coping style and social support. Result showed that women
with cluster headache anticipated fewer activities for themselves than
women with migraine and findings were similar in the male pairs. The men
with cluster headache also anticipated significantly fewer activities for
themselves in the present and with others in the present and in the future
than the men with migraine. There was no significant difference as to
emotional loading between the two groups. A tendency to more optimistic
anticipation was found in the women with cluster headache. There were
highly significant differences between the two groups in the ‘future wheel.
The group with migraine expected more concrete activities and more
activities with their families in the future, and they also describes their
present situation to involve more activities with others. Results from the
‘present study differ from those from studies utilizing more conventional
questionnaires. In particular, they found that patients with cluster headache
have fewer close social contacts than patients with migraine.

Pedro Montoya et al (2004) reported the effects of social support

provided by the presence of patients significant other on pain ratings, pain
thresholds, and brain activity associated with tactile stimulation in I S
fibromyalgia (FM) patients and 18 migraine patients (controls), and to
assess the influence of emotional context on thermal pain perception and

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processing of non-pain related information. The thermal pain thresholds
indicated greater sensitivity in FM patients than in migraine patients, as well
as enhanced sensitivity at the elbow than that at the fingers. Specifically, in
FM patients, there were significant reductions in pain sensitivity and
subjective pain rating when patients were stimulated at the painful tender
point in the presence of their significant others as compared with the ratings
when the patients were alone, Brain activity elicited by elbow stimulation
was also significantly reduced in FM patients when a significant other was
present as compared with the activity when the patients was alone. These
effects were not observed in the migraine patients.

Margot shields (2004) worked with the objectives of describing stress

exposure among Canadians aged 18 or older and analyzed short- and long-
term associations with psychological distress and chronic conditions. The
buffering role of emotional support was also considered. Using data from
the National Population Health Survey (CCITS), this article described the
stress levels of Canadians adults and how stress levels vary by demographic
and socio-economic characteristics. Based on 1994/95 cross sectional data,
association between stress and psychological distress and chronic conditions
were determined. With longitudinal data stress in 1994/95 was studied in
relation to changes in psychological distress and the incidence of chronic
conditions by 2000/01. These relationships were examined using
multivariate techniques to control for the influence of other variables that
might affect the outcomes. Findings indicated that the prevalence of chronic
conditions were related to stress. The role of emotional support plays in the
relationship between stress and mental and physical health was also
considered.

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The Specific objectives of the present study were as follows :

 To examine the relationship between social support and migraine

headache.
 To explore the relationship between subjective wellbeing and
migraine headache.

Following hypothesis were formulated for the present study:

 There would be more social support deterioration in migraine patient

than in normal control.

 There would be more deterioration in positive own perspective

(subjective wellbeing) in migraine patient than in normal control.

 Hierarchy and severity of various migraine headache differ in urban

and rural population. Urban population would experience more
migraine headache in comparison to rural people.

 Migraine head ache would negatively correlated with social support

and subjective wellbeing in both urban and rural population.

 Female migraine patients will experience low level of social support

as compared to male migraine patients consequently they will score
low on social support scale as well as compared to male migraine
patients.

 Female migraine patients will experience significantly impaired

subjective wellbeing as compared to male migraine patients;
consequently they will score low on subjective wellbeing scale.

Coverage Area : The study was conducted and patients were selected from
various places of Patna district.

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Sample

The study was conducted on a sample of 100 migraine headache

subject and 100 normal controls subject selected from urban and rural
population in equal proportion. Stratified random sampling method has
adopted in selection of the subject.

Following inclusion and exclusion criteria was adopted to make the

group more homogeneous.

Inclusion criteria :

 Only those cases selected as migraine patients who fulfilled the

diagnostic criteria of migraine.

 age range between 20-25.

 Education at least up to High School.

Exclusion criteria :

No any history of psychiatric or organic mental disorder. Adequate

view and hearing.

Another group of 100 controls (50 male and 50 female) of the same
age range and education was also included in the sample who did not had
any history of psychiatric, psychosomatic or organic problems and they
possessed normal physical health.

Tools :

1. PGI Social Support Questionnaire (Ritu Nehra, Parmanand

Kulhara and Dr. Santosh K. Verma, 1987)

Pollack and Harris scale was tried out in Indian psychiatric patients by
Nehra and Kulhara (1987). Their results indicated that 16 items had

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significant discriminating capacity and high test-retest reliability. So it was
decided to adapt it in Hindi.

2. Subjective well being scale

Subjective well being scale was constructed by Srivastava and

Singh (2003). This scale was consists of 28 items. In the scale 26 items are
positive and there are 3 items negative in the scale.

Positive item : 1, 2, 3, 4, 5, 6, 7, 9, 10, 11, 12, 13, 15, 16, 17, 18, 24
21, 22, 24, 25, 26, 27, 28, 29

Example- 1. esjk thou cgqr dqN esjs vkn”kksZa ds vuqlkj

gSA

2- eSa vius thou ls larq’V gw¡A

Scoring of positive times 4, 3, 2, 1, 0

Negative Items : 8, 14, 19

Example- 1. eSa bl ftanxh ls mc x;k gw¡A

2- eSa leL;kvksa ls yM+rs&yM+rs Fkd x;k

gw¡A
Scoring of negative items : 0, 1, 2, 3, 4

Higher score on this scale indicate better subjective well-being.

Procedure :

The above mentioned devices were administered to the selected

migraine patients and control groups. The literate subjects were asked to
read the instructions and write the response in the presence of the
investigation. For illiterate subjects the questionnaire was read out and their

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rating were recorded by the investigation. In the oral presentation of
question, due to attention was paid to explain the rating by wring example.

Result

Present findings indicate low level of social support in migraine

patients in comparison to normal control group. It is important to assess the
amount of social support available to the individual and to assess its
protective role for the individual. It refers to information leading and
individual to believe that he is cared and loved, seemed and valued and he
belongs to a network of communication and manual obligation present
findings show that migraine patient do not like to work in social pressure
but they fill to do, so they want to cut of from the group or they fill isolated
from the group. Summarizing the finding obtained from this study, it can be
predicted that psychosocial factors are the important pathogenic contributors
to migraine. The patients groups suffering from migraine are found to be
hanging a poor subjective wellbeing which indicates that migraine patients
are emotional and easily influenced by social pressure. Findings of this
research work may be utilized by clinical psychologist. Migraine is more
than just a ‘bad headache’, it has a tremendous impact on a patient ability to
carry out ordinary daily activities. Unlike a simple headache, migraine is
complex and extremely disability, episodic condition, which has a
significant impact of a lives of millions of people worldwide. Indeed, the
WHO has identified migraine as one of the world’s 20 leading causes of
disability. Recent estimates suggest that migraine affects approximately
11% of the worlds adult population were as in fact only 20% of patients
who visit their physician for an initial appointment continue under the
physician’s care actually it is severe, episodic disorder with freedom from

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symptoms between attack. Attacks are charactertized by transient focal
neurological symptoms headache or both. Symptoms have a duration of 7-
72 hrs. and can occur at any time. Headache pain is often on one ride of the
head (unilateral) and regularity accompanied by nausea, vomiting and
sensitivity to light and or sound (photophobia & homophobia). Symptoms
generally increase in intensity as the headache process. In young children,
migraine may be shorter in duration and headache pain commonly bilateral
in nature. Headache symptoms can be so intense as to interfere with a
sufferer’s ability to undertake normal daily activities and can be in
capacitating to the extent that sufferers required bed rest.

To a large extent, physical-geographical, social and socio-cultural

properties govern the conditions that will be perceived as particularly
threatening for a population. Through common laws, norms, rules,
traditions, attitudes and values, cultural and social factor regulate individual
perception and interpretation of the situational circumstances, they
encounter.

It is assumed that various social situation will be perceived as

threatening (Stressor) differently by the people from different geographical
location (e.g. rural, urban, slum, mountains, plains and deserts etc), different
ethnic groups, diffect socio-economic level etc. social support and
subjective wellbeing both are influence every individual’s physical
condition. It refers to the perceived comfort, caring, esteem or help a person
receives from their people or groups. This support can come from many
different sources e.g. the person’s spouse or lover, family, friends,
coworkers classmates, physician or community organization. The family is
an important source of social support. People with social support believe
they are loved and cared for, esteemed and valued and part of a social

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network, such as family or community organization that can provide goods,
services are mutual defense in times of need or danger.

In recent years there has been tantalizing research into the painful
consequences of people’s location in stratified economies and social status.
In view of assumptions that the bad subjective well being factors also
govern the condition that will be perceived as particularly painful for a
population and that the components and by products of culture regulate
peoples perception evaluation of situational circumstances they confront the
present study aim at testing the validity of the phenomenon of migraine
induced factor. Subjective wellbeing is a field of psychology that attempts
to understand people evaluation to their lives. These evaluation may be
primarily cognitive or may consists of a frequency with which people
experience pleasant emotions and unpleasant emotions. The field of
subjective well being includes the undesirable states that are treated by
clinical psychologist, but is not limited to the study of these undesirable
states. This field is concerned not just with the causes of anxiety, migraine
pain & depression, but also with the factors that differentiate slightly happy
people from moderately happy and extremely happy people.

A person’s evaluation of his live may be in the form of cognition and

affect. Thus a person is said to have high subjective wellbeing if he
experiences life satisfaction and frequent joy and only infrequently
experience unpleasant emotions such as sadness and anger contrariwise, a
person is said to have low subjective well being if he is dissatisfied with
life, experiences little joy and affection, and frequently feels negative
emotions such as anger or anxiety.

There has been considerable debate regarding relative contribution of

social support and subjective wellbeing in migraine patients. It is not clear

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whether and what extent social support and subjective wellbeing are
responsible to create symptom of migraine patient. Against this background
the present study attempts to examine whether the lack of social support and
subjective wellbeing in migraine patients is a consequences of society on the
persons maladjustment.

The design of the present study was 2 x 2 ANOVA mixed factorial

with repeated measures on last factor. The descriptive analysis showed that
migraine patients perform law score on social support questionnaire which
indicates the role of social support in healthy life. This type of support
involves the expression of empathy, carthy and concern toward the person.
It provides the person with a sense of comfort, belongingness and of being
loved in times of migraine attack. Results obtain by the statistics also
indicate that there is significance difference between migraine patient &
normal control group on social support test. There is rapid decline in scores
of migraine subject. These finding attest the hypothesis that migraine patient
would perceive low level of social support as compared to normal control
without esteem support person cannot do positive expression because
esteem support occurs through peoples expression of positive regard for the
person, encouragement or agreement with the individuals ideas or feeling
and positive comparison of the person with others.

In order to ascertain the role of subjective wellbeing between

migraine and normal patients the results were analysed. Results showed that
normal control have higher level of subjective well being in comparison to
migraine patients. Result revealed that there is significant impact on
subjective wellbeing of normal control and migraine patients. Subjective
well-being refers to the degree to which individual judges the overall quality
of his life as positive and favourable. Since it is subjective, hence it is within

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the individual and depends on people’s judgment about what it means to be
well. Migraine patients cannot evaluate their lives, life satisfaction and
marital satisfaction they have also gloomy mood and negative emotion such
as aggression & less empathy.

ANOVA showed that there is significant difference between migraine

and normal sample on social support and subjective wellbeing
questionnaire. Migraine patients have lack of network support which
provides a feeling of membership in a group of people who are interests and
social activities emotional and informational support may be particularly
important for people who are suffered from migraine symptoms. Results
also indicated that migraine patients have impairments of subjective
wellbeing which extend the theory that subjective wellbeing is defined in
term of the internal experience of the respondent. An external frame of
reference is not imposed when assessing subjective wellbeing. It is
measured from the individuals own perspective. If a individual thinks his
life going well, they it is going well within this framework. such as people
who are less able or worse offer. This kind of social support serves to build
the individual feeling of self worth, competence and of being valued. It is
specially useful during the appraisal of migraine attack, such as which the
person assess whether the demands exceed his personal resources.

The result recorded a comparative picture of the rural and urban

setting of migraine patients with regard to their social support. Finding
revealed that urban group experienced lower degree of social support in
comparison to rural group. The analyses also revealed that urban sample
experienced comparatively more tension & stress in all spheres of their day
to day life. Economic burden and constraints, excessive responsibilities and
liabilities and threat to social status and prestige were the predominant

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social stressors in all the subgroup in population sample. Urban people have
lack of information support which induce migraine symptoms. Information
support involves giving advice, directions, suggestion or feedback about
how the person is doing. For example a person who is ill (migraine) might
get information from family or a physician on how to treat the illness or
someone who is faced with a very difficult decision on the job might receive
suggestion or feedback about his ideas from coworkers.

Conclusion

The study induced us to draw following conclusion.

1. Person found most difficult in living with migraines, and in that

regard what kind of assistance would be most helpful to them and to
other person who had migraine headache. They conceptualized five
themes (a) impact on family (b) misunderstanding by other (c) effects
on others (d) physician care issues (e) issues related to medical
insurance.

2. A tendency to more optimistic anticipation was found in migraine

patients and the group of migraine expected more concrete activities
as more activities with their families in the future.

3. Mood state, ways of coping, perceived stress and social support are
significantly influencing factor on symptom of migraine.

4. Finding indicated that subjective well being successfully

distinguished with migraine patients and normal group. Migraine
suffer person thinks that his life is going not well so internal
experience of the respondent are influence.

The present series of 2 studies has unequivocally demonstrated the

social support and subjective well being impairment in migraine patient

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which indicates that migraine patient do not like to work in social pressure
but they fill to do so they want to cut of from the groups or they fill isolated
and poor subjective wellbeing. This type of finding predicted that
psychosocial factors are one of the important pathogenic contributors to
induce migraine.

Limitations :

The study suffers from some limitations, which are given below:

1. The present study drawn from urban and rural area of Patna district
on small sample (N=100). So findings are limited to fixed
populations, not for large population so the results of the study may
not be generalized for the person.

2. This study migraine patients were taken in the limited sample and
screening criteria of migraines are also limited.

Suggestions

Based on observation, findings and subsequent conclusions of this

study. The following suggestions are given for the further research.

The present study is limited to only few psychological aspects (sex,

area, social support & subjective wellbeing). Other psychological aspects
(Locus of control, alienation, social status self esteem) may be taken in
addition to these variables in future research. The present research was
based on only small sample so similar studies should be conducted on the
large sample.

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