Impact on Physical Health Aspects of Quality of Life of Patients with Chronic Headache in Isfahan in 2015

Headache is the most common pain syndrome and more than 90 percent of people over the year have had an attack. Due to the high prevalence of headache in the world and Iran, and its impact on quality of life and because of side effects of chemical drugs and the high cost of current treatments, this study aimed to investigate the effect of homeopathy on physical health aspects of quality of life of patients with chronic headache and performed in Isfahan in 2015. This quasiexperimental is the kind of single group, and it is a before and after. The questionnaire consisted of demographic and quality of life (SF-36). Sampling is available, in which 51 patients with chronic headache in a way that met the inclusion criteria. Before making a homeopathic demographic questionnaire and the consent were completed by patients and quality of life questionnaire in two stages prior to undertaking homeopathy and the again three months later it was completed by patients. In order to analyze the data, SPSS20 software was used. In this study, homeopathic significantly improve the physical health aspects of quality of life of patients with chronic headache and the differences between pretest and post test scores was significant (p > (05/0). The results showed that homeopathy can be effective in improving physical health aspects of quality of life of patients with chronic headaches and be used as a useful method of treatment.


INTRODUCTION
In fact one of the most common physical side effects are headache, headache is a symptom, not a disease.Headaches can be a symptom of organic disease, stress responses, dilation of cerebral blood vessels, skeletal muscle tension or set of factors listed 1 .Headache is the most common pain syndrome and more than 90 percent of people each year experience at least one headache.Annually, 240 million suffer from 4.1 billion headache attacks4.1,lifetime prevalence of headache in men 93% and in women 99% have been reported.Prevalence of headache in different societies is different, so that it is reported in Norway, Brazil, Turkey, Qatar, Saudi Arabia, Yugoslavia and Kenya equal to 76.8% 82.9% 49.2%, 85%, 49.8%, 66%, and 88%.And in all cases, prevalence of headache in women is more than men 2 .In Iran, since about half of patients do not see a doctor, determine exact amount of the population is difficult.In various studies conducted in Iran, Migraine prevalence in Shiraz 7.4%, in Rasht 8.8% and in Shahrekord 13.3% have been reported 3 .The effects of chronic disability caused by migraine has been less studied.Compared to other chronic diseases such as diabetes, hypertension and coronary heart diseases, quality of life in people with migraine has been a lower degree.In patients with chronic daily headache not only in the field of public health and reduce physical exertion and the quality of life, but also in terms of mental health, there is also the loss of quality 4 .For the young people, chronic headaches cause missed school days, reduce their quality of life and athletic activities 5 for the treatment of headache, various methods including conventional medicine, chemical drugs, and a variety of complementary medicine including acupuncture and homeopathy can be used.From the perspective of the World Health Organization, homeopathic medicine is one of the most holistic and complementary medicine, which has more than 200 years old, it is a comprehensive and independent treatment protocol and can be most effective.The word "homeopathy" is a combination of two words; the word "homeo" which means similar and the word "pathy" which means disease 6 .This means that the nature and extent of drug action plan is a condition or state of ill-health therapist must have the same symptoms 7 .One of complementary medicine therapies effective in chronic diseases 8 .Since one of the primary goals in providing health care by nurses, is improving the quality of life of patients with headache, this study was conducted to evaluate the effects of homeopathy on physical health aspects of quality of life of patients with chronic headache in Isfahan in 2015.

MATERIALS AND METHODS
This quasi-experimental is the kind of single group, and it is a before and after.Which was carried out in early August 2015 to late October 2015 office visit two of the city homeopathic physicians.The study population included all patients with chronic headache who visited the homeopath doctor's office the in Isfahan in 2015.With a sample size formula for the mean difference test, before and after the intervention, the formula was used: Upon which to perform the two-sided test in significance level of 5% (α=0.05), with a test power of 90% (β=0.1) and for the difference in size of 5.0 standard deviation (σ5/0=ε), the required sample size was estimated at 36. 9 .with the possibility of sample loss, 64 patients were selected who met the inclusion criteria.Of these, 13 patients withdrew and finally, this study was conducted with 51 people.Entry requirements include a signed consent form and willingness to participate in research and exclusion criteria from the study include failure to complete homeopathic remedy.Assessment instrument was a demographic questionnaire and quality of life questionnaire (SF-36).The questionnaire included demographic information such as age, sex, marital status, education, income and occupation.SF-36 questionnaire that its validity and reliability have been proven in Iran, has 36 expressions and includes two subscales of mental and physical health 10 .Before the intervention, patients completed a demographic questionnaire and quality of life questionnaire SF-36.Then treated with homeopathic medicines within 3 months.After this period, they again completed the quality of life questionnaire 36-SF.After collecting the data entered into the computer, and then statistical tests were analyzed by software SPSS 20, the data were both descriptive and analytic that the frequency, distribution, mean table was used in the descriptive level and paired t-test was used at the level of inference.

Findings
This study was conducted on 51 patients with chronic headache, the average age of patients was 9.06± 35.47 and 29.4% were male and 70.6% were female.84.3% of the patients were married and in terms of education, the most frequently observed among patients (2/39 percent) were related to people with high school diploma.37.3% of the patients were employed, and the average income of employed people was equal to 0.51± 1.3 million Toman (Table 1).Also according the results table (2), paired t-test result showed a significant difference between the mean scores of patients before and after intervention in terms of physical functioning (p<0/ 05) and life quality scores in physical functioning in patients after the intervention significantly higher than before intervention.
The result of paired t-test showed a significant difference between mean scores of patients before and after treatment in terms of physical role(p<0/05) and the average score of The result of paired t-test showed a significant difference between mean scores of patients before and after treatment showed in terms of physical pain(p<0/05) and the average score of quality of life in terms of physical pain after the intervention significantly higher than before intervention.
Result of paired t-test showed a significant difference between the mean scores of patients before and after treatment in terms of public health (p<0/05) and mean scores of quality of life in terms of public health after the intervention significantly higher than before intervention.

DISCUSSION
The results showed that the average age of patients with chronic headache was 35.47 ± 9.06, which was in line with the results of Abdi et al 11 entitled "The impact of high-intensity eight weeks aerobic training on measures of migraine" and the average age of the study also was equal to 12.3± 34.1 and also is consistent with previous results of Taziki et al (12) entitled "personality characteristics of migraine and tension-type headache" in which the mean age of patients was equal to 11.92 ± 34.94.Of these, 29.4% were male and 70.6% were women, which is consistent with the results of Khosropour et al., 13 and Fallah et al., 14 and Yaqini et al., 15 and all of these studies showed that women suffer the most from this disease.84.3% of the patients were married, which is consistent with the results of Aghapour Zanganeh and et al., 16 .Based on the results, 62.7% were unemployed, which is consistent with results of Bahraini 17 .The results showed that homeopathy has a significant effect on physical health of quality of life in patients with chronic headache.In terms of physical function, physical role, Paired t-test results showed a significant difference between the mean scores of patients before and after the intervention (05/0> p) and mean scores of quality of life after treatment was significantly higher than before the intervention.These results were in line with the findings of Bryan et al entitled "homeopathic clinical benefits for patients with rheumatoid arthritis", which showed that homeopathy has a positive effect on physical function and physical role 18 .The findings of the study on the impact of physical border homeopathic patients with chronic headache showed significant differences comparing planned paired t-test and post-test analysis confirms this difference.The mean score of quality of life after physical pain after treatment was significantly higher than before the intervention, which is consistent with a study of Claudia et al.,19 called the effectiveness of the quality of life of breast cancer patients treated with a variety of complementary medicine, including homeopathy.It also is consistent with the results of Abraham and et al., 20 entitled comparison with homeopathy and acupuncture treatment of knee osteoarthritis showed that acupuncture on pain in this case, however, the impact is more effective, but also homeopathy has an effect on pain.In terms of public health, the results of this study could prove homeopathy positive impact so that the result of paired t-test showed a significant difference between the mean scores of patients before and after the intervention (p<0/05) and the average score of quality of life after public health after intervention was significantly higher than before the intervention.These results are consistent with results of Dunn et al., 21 entitled "The effect of homeopathic remedies on outpatients with influenza and diseases of the ear, nose and throat".

CONCLUSION
The results of this study showed that homeopathy as one of the top complementary medicine has a positive impact on physical health aspect of quality of life of patients with chronic headache.The benefits of this treatment for patients with chronic headache are no side effects of treatment with homeopathic remedies, easy and inexpensive treatment and strengthen the vitality of the individual and ultimately, improve the quality of life.

Ethical considerations
Adequate explanations about the object and purpose of the study were presented to the research units.It was explained that they can withdraw from the research at any time.All stages of the study was approved by the Ethics Committee of Medical Sciences and Ethics Code number: IR.MUI.REC.2015.4.59 is intended for this study.

ACKNOWLEDGMENTS
The researcher are obliged to appreciate all persons who have worked in this study, especially patients with chronic headaches referred to homeopathic physicians