This study provides, for the first time, a comprehensive assessment of HRQoL and its associated factors in Chinese patients with MM. We found that HRQoL in MM patients is lower in five HRQoL dimensions (PF, RF, GH, SF, MH) than in NMM patients. Additionally, in the stepwise linear regression model, we found that PCS is related to headache frequency, symptoms of depression, and impact of headaches on daily life. MCS is linked to symptoms of depression, suicidal ideation and social support in patients with MM. Such findings pave the way for scientific strategies to improve the quality of life of patients with MM.

Migraine increases patient burden [18]and seriously affects their quality of life [8]. Nicodemo et al. used the SF-36 to assess MM’s quality of life and found that MM’s scores in all six HRQOL dimensions (PF, RP, BP, GH, VT, SF) were lower than in healthy women. health, and there is no significant difference in the scores of the two dimensions (RE, MH) [19]. Based on the severity and refractoriness of MM, we performed a migraine subgroup analysis to compare HRQoL in patients with MM and NMM. We found that MM patients had lower mean scores for all five dimensions (PF, RF, GH, SF, MH) compared to NMM patients, and there were no statistically significant differences in scores for the three. dimensions (BP, VT, RE). Additionally, patients with MM had lower scores than NMM for PCS and MCS.

Our study demonstrated that symptoms of depression are independently associated with PCS and MCS, after adjusting for confounding factors. Depression is a common comorbidity in migraine patients, and HRQoL was reduced in patients with both migraine and depression compared to migraine patients who were not depressed [20]. A recent study in the United States found that symptoms of depression are a predictor of headache frequency and migraine-related disability. [21]. Therefore, it is not difficult to understand that the symptoms of depression are closely associated with physical and mental health. In agreement with the results of the study in Brazil, we demonstrated that the severity of symptoms of depression is a predictor of HRQoL in MM [22]. Pradeep et al. reported that the presence of depression added to the extent of migraine-related disability and decreased the quality of life of migraine patients, which is similar to the results of our study. [23]. This study [23] also found that anxiety had a negative impact on the quality of life of migraine patients. In our study, although univariate analysis showed that anxiety symptoms could be a significant risk factor for HRQoL in patients with MM, no significant difference was detected by multivariate analysis. At present, it cannot be certain that anxiety symptoms are independently associated with HRQoL in patients with MM.

MM patients who reported more frequent migraine attacks and greater impact of headaches on daily life might impair HRQoL by affecting their physical health. A downward trend in migraine quality of life was noted with increasing headache frequency [20]. Previous studies have proven that more frequent migraine attacks and greater impact of headaches on daily life were predictors of adverse effects on the quality of life of migraine patients. [23], which is similar to our results. In a recent study, Irimia found that a positive linear association between headache frequency and the risk of anxiety, depression in migraine patients [24]. Patients with monthly headache days ≥ 3 days are at higher risk for anxiety, while those with ≥ 19 days are at risk for depression. Additionally, patients with monthly headaches ≥ 10 days are often accompanied by severe disability [24]. Interestingly, patients with only one to six headaches per year still show reduced quality of life, this could be due to the unpredictability of the attacks magnifying the effect of the few days of headaches leading on quality of life in a remarkable way [20]. Richard et al. [25] examined the association between headache-free days and migraine burden, and found that headache-related disability shows a decreasing trend with increasing headache-free days [25].

Our research showed that perceived social support is positively associated with MCS. An Italian study of chronic migraine patients with medication overuse found that social support is a predictor of quality of life to some extent [26]. Additionally, a French study also found that the higher the perceived social support, the higher the likelihood of being an active migraine consultant. [27, 28]. This headache counseling enabled patients to actively take prevention and treatment strategies to minimize the burden of migraine and relieve unwanted emotions, and thereby engage more in social activities and improve HRQoL, by particular HRQoL related to mental health.

Like the limitations in daily social and occupational activities caused by migraine, patients’ mental health has been affected, and severe cases can lead to suicidal ideation. Our research revealed that suicidal ideation can affect MCS and could therefore predict the quality of life of patients with MM. Many researchers have agreed that migraine patients are associated with poor quality of life and a higher likelihood of suicidal ideation. [8, 9, 29, 30]. This study demonstrated, for the first time to our knowledge, the correlation between HRQoL and suicidal ideation in MM patients. Providing psychological treatment to MM patients with suicidal thoughts can help reduce the risk of suicide, as can applying active treatment, improving their mental health and quality of life.

As a clinical migraine trigger, sleep disturbances may contribute to the vicious cycle [31]. Although sleep quality was associated with PCS and MCS of patients with MM in the univariate analysis, it was no longer a significantly associated factor after adjusting for potential confounders in the multivariate model. Thus, we cannot consider sleep quality as a predictor of HRQoL in MM patients. In the current study, evidence describing the relationship between sleep quality and HRQoL was still insufficient in migraine patients [32]and this result is consistent with the previous study.