Headache Medicine 2021, 12(2) p-ISSN 2178-7468, e-ISSN 2763-6178

ASAA

Headache Medicine

DOI: 10.48208/HeadacheMed.2021.19

Review

Is it possible to sort the disability of individuals with migraine

based on the International Classication of Functioning, Disability

and Health? A Scoping Review

Hugo Feitosa , Débora Wanderley , Manuella Morais Monteiro Barbosa Barros , Suellen Freitas da Silva ,

Alyne Karine de Lima Santos , Angélica da Silva Tenório , Daniella Araújo de Oliveira

Universidade Federal de Pernambuco, Recife, Brazil.

Abstract

Purpose

To identify the most frequent outcomes related to disability assessed in individuals with mi-

graine and to correlate these ndings with the categories of International Classication of

Functioning, Disability and Health.

Material and method

This scoping review was developed based on studies with adult population (18-55 years)

of both sexes and assessing the disability generated by migraine. We included studies in

which patients had a diagnosis of migraine based on International Classication of Hea-

dache Disorders.

Results

52 articles were found with 42 outcomes related to 17 categories of International Classi-

cation of Functioning, Disability and Health, including the four main components of the

classication, with seven categories in "Body Functions", one in "Body Structures", four in

“Activities and Participation” and ve in "Environmental Factors".

Conclusion

The ndings show that disabilities, activity limitation, or participation restriction generated

by migraine can be classied by International Classication of Functioning, Disability and

Health. The components "body functions", "environmental factors" and "activities and par-

ticipation" were the most identied in the present study. Thus, this classication is important

to classify the disability caused by migraine and to guide a rehabilitation more focused on

the patient's real demands, as well as directing the research involving this population.

Hugo Gabriel Feitosa de Souza,

Department of Physical Therapy,

Federal University of Pernambuco,

Av. Jorn. Aníbal Fernandes,173 –

Cidade Universitária, Zip Code:

50740-560, Recife –PE.

Phone: + 55 (81) 2126.8937.

E-mail: hugogfeitosa@gmail.com

Edited by:

Marcelo Moraes Valença

Keywords:

International Classification of Func-

tioning

Disability and Health

Sickness Impact Prole

Environmental Health

Migraine disorders

Disabled Persons

Received: September 30, 2021

Accepted: October 5, 2021

ASAA

Feitosa H, Wanderley D, Barros MMMB, Silva SF, Santos AKL, Tenório AS, Oliveira DA

Is it possible to sort the disability of individuals with migraine based on the International Classication of Functioning, Disability and Health? — A Scoping Review

Introduction

igraine is the third-most prevalent disease in the world

and the second one to cause larger numbers of lost

work days due to a disability.

Sleep disorders, decrease in

the perception of quality of life and the well-being sensation

and increase in anxiety crises have been related to migraine

crises, in addition to the inuence in social function due

to disability and decreasing social status caused by this

condition.

2-5

In this way, there are severe impacts of migraine on the

quality of life and social function of the affected individuals,

which makes this illness affect a wider spectrum as it

generates psychological and social problems for both the

affected individual and the social environment to which he

belongs to either for the greater difculty in maintaining

social relations or even for the economic impacts caused

by the reduced productivity of migraineurs.

1,4,6

Because migraine is a disease that causes negative

impacts that go beyond biomedical issues, the World

Health Organization (WHO) instituted the International

Classication of Functioning, Disability and Health (ICF),

whose classication model seeks to obtain a broader

view of the health-disease process. Thus, it is important

to assess migrants in a broader perspective that covers

physical, emotional, psychological, functional, social and

environmental conditions.

6,7

Despite the exposed, there is a gap in literature about

biopsychological issues generated by migraine that have

undeniable implications on the patients’ functioning.

Therefore, the application of ICF is a way to classify the

functioning of this population, since this proposal focuses

on the patient’s approach on this broader vision as

adopted by the WHO.

6,7

Therefore, the present study aimed to conduct as coping

review to map the most important implications of migraine in

a patient’s functioning from the main disabilities presented

by this population in the past studies.

Material and Methods

It’s a scoping review recorded on Open Science Framework.

Design

In as coping review, the methodology seeks to map

the determined subject through a systematized starting

point, including summarization and analytical review of

published texts.

8,9

As coping review proposal is to search

for information regarding the selected process, which

frequently demands that diverse outcomes be used. Thus,

such review can act as a tool for conducting systematic

reviews as suggested by past data.

The standard model,

as proposed by Joanna Briggs Institute Manual, suggests

the following: 1. Creation of title, aim, and conductor

question to be answered;2. Choice of sources and search

for data chain are followed by study selection and data

extraction; and 3. Presentation of results and practical

implications.

It is important to highlight that, in the study selection, as

proposed by the Joanna Briggs Institute guide, inclusion and

exclusion criteria were applied, based on the population,

context, and concept, with the aim of responding to the

conductor question of “what are the disabilities related to

adult patients with migraine?”

Inclusion Criteria

Population

Adults (18–55 years) of both the sexes were included

in this review, considering that migraine affects different

age groups and also this age group represents the higher

prevalence range.

Concept

Disability has been the searched concept dened by WHO

as a term that includes deciencies (related to functions

and structures), limitations (joined to performed) activities,

and restrictions (related to social participation) as well as

environmental factors interacting with these constructs.

Context

Studies that assessed patients with a prior diagnosis

of migraine were included, as per the International

Classication of Headache Disorders (ICHD) Versions I

, III-Beta

, with the objective of broadening the impact

spectrum of migraine patients included in hospitals,

outpatient clinics, specialized centers for headaches, or in

their own communities.

Study Selection

The searches were conducted from November 2017

to June 2018 and updated on June 2020, by a trained

personal in the following databases: Medine/Pubmed,

ASAA

Feitosa H, Wanderley D, Barros MMMB, Silva SF, Santos AKL, Tenório AS, Oliveira DA

Is it possible to sort the disability of individuals with migraine based on the International Classication of Functioning, Disability and Health? — A Scoping Review

Lilacs, Cinahl, Scopus (Elsevier) Web of Science, and

Cochrane Database of Systematic Reviews, by using

indexed descriptors and keywords, without restriction of

year of publication, language or study design.

Research Strategies

In the databases Medline, Scopus (Elsevier) Web of

Science, and Cochrane Database of Systematic Reviews,

we considered the following descriptors of the Medical

Subject Headings (MeSH): “Migraine Disorders”,

“Disability Evaluation”, “Quality of Life”, and the keyword

“Functioning”. For a Lilacs basis, we considered the

descriptors in Health Sciences (Migraine Disorders),

Quality of Life, Disability Assessment, and a keyword

“Functioning”. From the database Cinahl, we used the terms

of its titles: “Migraine”, “Disability Assessment”, “Quality of

life”, “International Classication of Functioning” “Disability

AND Health” AND “Functioning”.

The Boolean operator “AND” was used to cross the descriptors

by dening the search strategy (Figure 1).

Primary Identification of the Articles

Initially, the studies shortlisted from the search strategies

were identied by title and abstract and summarized so

that two independent researchers could judge whether they

were relevant to answer the conducting question. In case

of a disagreement, a third researcher would be activated

to assist in clarifying doubts and taking a nal decision

about the relevance of the article. In cases where, even

after taking these measures, the article relevance was still

considered dubious, it would be included for the reading

phase of the full text for deeper clarication. Next, those

articles that met the inclusion criteria and could adequately

answer the guiding question were nally included in the

study.

Data Extraction

For this phase, a spreadsheet was created in the Microsoft

Excel Program to be lled with each study data. The ones

collected from each study included: article title, authors’

names, publication date, diagnostic criteria, population’s

age range, main study outcomes, and tools used for this

aim.

We then organized a table with these data by relating the

outcomes found with the equivalent ICF categories in the

sense of identifying the ones that were more relevant for the

assessment of patients with migraine.

Results

Figure 2 shows the capitation owchart of articles in this

review. In the initial search, 2,567 articles were found, of

which 979 were repeated between databases, 889 were

excluded after reading their titles or abstracts, and 698

articles were considered relevant for reading the text.

After the complete reading of the articles, 584 of them

were excluded because they did not meet the inclusion

criteria or for being considered irrelevant for the study.

With this proceeding only 114 were taken to the phase of

data extraction. In these 114 articles, we have identied

that 60 studies used exclusively the result of validated

questionnaires for patients with migraine: Migraine

Disability Assessment (MIDAS), Headache Impact Test-6

(HIT-6) e Migraine-Specic Quality of Life Questionnaire

(MSQ). For recognizing the importance of such

questionnaires in the assessment of patients with migraine,

these studies were considered relevant and included in

this review. However, at the moment of data extraction, it

was not possible to identify what functional aspects of the

patients were affected, since the presentation of results of

these studies did not permit to identify which categories

were more relevant in this population. Because of this,

just the 52 remaining articles had their data extracted,

tabulated and categorized in our study.

Description of Articles

The 54 articles included in this review were published in

17 different countries, involving 13,383 patients, with a

mean age of 38.7 years, of whom 9,621 were women,

3,762 men and 2,264 were not identied in relation to sex

in the studies. As for the publishing location, it is possible

to highlight the United States as the place with larger

number of publications. These studies were published in

the interview from 1994 up to 2019, being 2012 the year

that presented the largest number of publications of the

articles included in this research (Table 1).

The study design most found in this study was randomized

clinical trial (23 articles), followed by cross-sectional studies

(13 articles), literature reviews, and then other types of

study (such as cohort, systematic review, control-case, and

qualitative), totaling 9 articles.

Table 2 shows the outcomes found in this scoping review

and the ICF-correlated categories. The assessed outcomes

in these articles were related to 17 ICF categories, of which

seven were for the components “Body Functions”, one for

ASAA

Feitosa H, Wanderley D, Barros MMMB, Silva SF, Santos AKL, Tenório AS, Oliveira DA

Is it possible to sort the disability of individuals with migraine based on the International Classication of Functioning, Disability and Health? — A Scoping Review

MEDLINE/Pubmed

#1 ("Migraine Disorders"[Mesh]) AND ("Disability Evaluation"[Mesh])

#2 ("Migraine Disorders"[Mesh]) AND ("Quality of Life"[ Mesh])

#3 ("Migraine Disorders"[Mesh]) AND (“Functioning”)

#4 ("Migraine Disorders"[Mesh]) AND "Cost of Illness"[Mesh]

Web of Science

#1 ("Migraine Disorders") AND ("Quality of Life")

#2 ("Migraine Disorders"[Mesh]) AND ("Disability Evaluation"[Mesh])

#3 ("Migraine Disorders"[Mesh]) AND (“Functioning”)

Lilacs

#1 (“Transtornos de Enxaqueca” [DeCS]) AND (“Avaliação de deciência” [DeCS])

#2 (“Transtornos de Enxaqueca” [DeCS]) AND (“Qualidade de Vida” [DeCS])

#3 (“Transtornos de Enxaqueca” [DeCS]) AND (“Qualidade de Vida”) AND (“Avaliação de

deciência” [DeCS])

#4 (“Transtornos de enxaqueca”) AND (“Funcionalidade)

Cinahl

#1 (“Migraine”) AND ("Disability Evaluation")

#2 (“Migraine”) AND ("Quality of Life")

#3 ("Migraine") AND ("International Classication of Functioning, Disability and Health”)

#4 ("Migraine) AND (“Functioning”)

Cocharne

#1 ("Migraine Disorders"[Mesh]) AND ("Quality of Life"[ Mesh])

#2 ("Migraine Disorders"[Mesh]) AND ("Disability Evaluation"[ Mesh])

Scopus

#1 ("Migraine Disorders"[Mesh]) AND ("Disability Evaluation"[Mesh])

#2 ("Migraine Disorders"[Mesh]) AND ("Quality of life"[Mesh])

#3 ("Migraine Disorders") AND (“Functioning”)

Figure 1. Search strategies for MEDLINE/ Pubmed, Lilacs, Cinahl, Cochrane Database of Systematic Reviews and Scopus (Elsvier) databases.

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Feitosa H, Wanderley D, Barros MMMB, Silva SF, Santos AKL, Tenório AS, Oliveira DA

Is it possible to sort the disability of individuals with migraine based on the International Classication of Functioning, Disability and Health? — A Scoping Review

Figure 2. Preferred Reporting Items for Systematic Reviews and Meta-Analyses ow diagram of included articles.

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Feitosa H, Wanderley D, Barros MMMB, Silva SF, Santos AKL, Tenório AS, Oliveira DA

Is it possible to sort the disability of individuals with migraine based on the International Classication of Functioning, Disability and Health? — A Scoping Review

Table 1. Characteristics of studies included in the scoping review (n =54).

Period Country Study Design n Period Country Study Design n

2013-2020

Italy

Turkey

RCT

2001-2004 Brazil Cross-sectional study 2

Cross-sectional study 1 USA Literature review 1

China Systematic review 1 Case-control study 1

Philippines Cross-sectional study 1 Cross-sectional study 1

Brazil Cross-sectional study 2 Longitudinal study 1

Iran RCT 1 France RCT 1

USA Literature review 1 Turkey RCT 1

RCT 2 Germany RCT 1

Spain Systematic review 1 1997-2000 USA RCT 1

Netherlands RCT 1 Literature review 1

2009-2012 USA RCT 6 France Cohort study 2

Brazil RCT 1 England Cross-sectional study 1

Thailand RCT 1 1994-1996 USA RCT 1

Taiwan Cross-sectional study 1 Netherlands Cross-sectional study 1

Switzerland Observational study 1 USA RCT 1

China RCT 1 India RCT 1

Iran Case-control study 1

2005-2008 USA RCT 2

Case series study 2

Observational study 1

Literature review 1

Qualitative study 1

Norway Literature review 1

Taiwan Cross-sectional study 1

France RCT 1

Note. RCT: Randomized Clinical Trial

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Feitosa H, Wanderley D, Barros MMMB, Silva SF, Santos AKL, Tenório AS, Oliveira DA

Is it possible to sort the disability of individuals with migraine based on the International Classication of Functioning, Disability and Health? — A Scoping Review

Table 2. Outcomes evaluated in studies included, related to International Classication of Functioning, Disability and Health categories and its

description (n =42).

Outcomes Found/ Tools Related Category Description

Body functions

Frequency of pain, intensity of pain/ Headache diary,

Visual analogue Scale

b280 Sensation of pain

Sensation of unpleasant feeling indicating potential or actual damage to

some body structure.

Energy and vitality/ SF-36 b130 Energy and drive functions

General mental functions of physiological and psychological mechanisms

that cause the individual to move towards satisfy specic needs and

general goals in a persistent manner.

Exercise tolerance, physical activity tolerance, worsens

with physical activity, aggravation with physical

activity, physical performance, vigorous activity/,

qualitative interview, anamnesis, Fatigue Severity

Scale

b4559 Exercise tolerance functions,

unspecied

Nausea and vomiting/ qualitative interview, free

question

b5106 Functions of expelling the

contents of the stomach, oesophagus

or pharynx

Functions of moving substances such as food, liquid, medications, objects

intentionally or unintentionally swallowed in the reverse direction to

ingestion, such as in regurgitation and vomiting.

sleepiness, sleep disturbances, to sleep, ability to

sleep/ qualitative interview, Epworth Sleepiness

Scale, Subjective sleep quality was assessed using the

Pittsburgh Sleep Quality Index

b134 Sleep functions

General mental functions of periodic, reversible and selective physical and

mental disengagement from one's immediate environment accompanied by

characteristic physiological changes.

Stress, mood, impact on mood, irritability/

Generalized Anxiety Disorder 7-item scale, Patient

Health Questionnaire 9-item Scale

b1263 Psychic stability

Mental functions that produce a personal disposition that is even-tempered,

calm and composed, as contrasted to being irritable, worried, erratic and

moody.

Memory/ Fear conditioning test, qualitative interview b144 Memory functions

Specic mental functions of registering and storing information and

retrieving it as needed.

Body structures

Head and neck/ Cervical Range of Motion,

algometry, Neck disability index

s710 Structure of head and neck

region

Activities and participation

Workdays lost, ability to work, work score, work

performance/ free questions, qualitative interview,

American Migraine Prevalence and Prevention, Years

lived with disability

d850 Remunerative employment

Engaging in all aspects of work, as an occupation, trade, profession or

other form of employment, for payment, as an employee, full or part time,

or self-employed, such as seeking employment and getting a job, doing the

required tasks of the job, attending work on time as required, supervising

other workers or being supervised, and performing required tasks alone

or in groups.

Leisure and recreation activities d920 Recreation and leisure Engaging in any form of play, recreational or leisure.

Social function, social activity, social interactions,

social isolation.

d9205 Socializing

Engaging in informal or casual gatherings with others, such as visiting

friends or relatives or meeting informally in public places.

To walk, ability to walk/ qualitative interview,

anamnesis, Fatigue Severity Scale

d450 Walking

Moving along a surface on foot, step by step, so that one foot is always

on the ground, such as when strolling, sauntering, walking forwards,

backwards, or sideways.

Environmental factors

School performance, intellectual performance, school

score, schooldays lost

e5850 Education and training

services

Services and programmes concerned with education and the acquisition,

maintenance and improvement of knowledge, expertise and vocational or

artistic skills, such as those provided for different levels of education

Light, strong lights and photophobia/ Headache diary,

anamnesis

e240 Light

Electromagnetic radiation by which things are made visible by either

sunlight or articial lighting

Sound, noise and phonophobia/ Headache diary,

anamnesis

e2500 Sound intensity

Level or volume of auditory phenomenon determined by the amount of

energy being generated, where high energy levels are perceived as loud

sounds and low energy levels as soft sounds.

Note. b: Body functions; s: Body structures; d: Domains; e: Environment

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Feitosa H, Wanderley D, Barros MMMB, Silva SF, Santos AKL, Tenório AS, Oliveira DA

Is it possible to sort the disability of individuals with migraine based on the International Classication of Functioning, Disability and Health? — A Scoping Review

“Body Structures”, four for “Activities and participation”,

and ve for “Environmental Factors”.

In the 60 articles that used some validated questionnaire,

but did not present results that could answer this review

question, totaled a population of 19,153 people, of which

15,703 were women and 3,273 men with ages 18–55

years (average age: 38.6 years).

Discussion

The disability classication of patients with migraine can

be performed through the ICF, but it is still an uncommonly

used instrument in studies developed in this thematic.

The validating tools for assessing the migraine impact

are unclear in their results about the aspects of life that

are more affected, besides being not able to address

satisfactorily the biopsychosocial aspects, the factors that

makes it imperative to majorly use the ICF in the disability

classication of patients with migraine.

Studies about the functioning of patients with migraine

are not a recent phenomenon. This review found articles

dated from the year 1994. In addition, there exists several

validated instruments to assess the disability measures

and migraine impact in several aspects of a patients’

life. Nevertheless, it was detected that identication was

difcult from the study’s results regarding the aspects of a

patient’s life that were more affected.

14-16

Body Functions

In this component, it was found that the most-prevalent

category of the studies of this scoping review was “b280

pain sensation”, which conrms the presently known

information about migraine, by considering pain as the

main characteristic.

It is therefore important to highlight,

however, that migraine has, more and more, presented

itself as a process not limited to pain sensation only.

Corroborating this observation, other ndings of this

review claries that factors joined to body functions show

alteration in migraineur’s population.

Despite this, the importance of this category is not

diminished since the pain frequency remains the most

important outcome in the assessment of this population for

altering the life quality signicantly and collaborating with

other following outcomes.

2,3,18

Furthermore, it was possible

to conrm, in the present review, that the most-assessed

outcomes in the studies of migraineurs’ populations were

related to pain sensation in the patient.

In “body functions”, the second-most frequent category was

“b 130 Functions of energy and impulses” that included

issues such as motivation, appetite, desire, and impulse

control.

There is a past study that demonstrated the

relation between migraine and the functions of energy as

well as the impulses when they demonstrate the thalamus

involvement in the alterations caused by migraine in

functions of food intake and anxiety control.

19,20

Furthermore, the outcome called vitality was included in this

category. Thus, the number of articles that used the Medical

Outcomes Short-Form Health Survey (SF-36), despite

the existence of specic and validated questionnaires,

increases the number of researchers that assessed this item.

However, the patients’ perception and the neuropathogenic

explanation of migraine itself demonstrates that this

category has relevance for a studied population, which

makes its presence imperative in instruments that seek to

assess or classify this population.

19,21-31

In 17% of the articles included in this review, the outcomes

related to the category “b5106 Regurgitation and

Vomiting” were found. It is therefore important to detach

that, in relation to qualitative studies, this category has

been constantly indicated by patients, which leads us

to believe that its impact in migraineurs’ quality of lives

remains underestimated by the studies now conducted with

this population.

32,33

Within the component Body Functions, is remains

important to highlight that 15.6% of the included articles

assessed the outcomes related to tolerance to physical

exercise or to “sleep functions”. Concerning physical

exercises, the established relation in larger part of the

studies found, reference to this issue of crises aggravation

with the performance of physical exercises.

21,34,35

However,

it was not related to the cardiovascular system, as would

be in the ICF category present in this component. Instead,

some existing studies are researching beyond this question

and have shown that, despite this established fact, the

performance of physical exercises between the periods of

crises have shown efcacy in the reduction of frequency

and in the intensity of crises in patients with migraine.

Therefore, it is important to further evaluate this point in

order to clarify what intensity of migraine diminishes the

tolerance to exercise with a differentiation of the periods

without and with crises.

36,37

Regarding sleep functions, a previous study

demonstrated

improvement in the sleep quality among treated patients

with migraine, while another one

established an

important relationship among patients who presented

100

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Feitosa H, Wanderley D, Barros MMMB, Silva SF, Santos AKL, Tenório AS, Oliveira DA

Is it possible to sort the disability of individuals with migraine based on the International Classication of Functioning, Disability and Health? — A Scoping Review

migraine and reduction in the sleep quality and the risk of

sleep apnea. This nding showed that, despite it not being

possible to establish a relationship between the cause and

effect, it has already been demonstrated that reduction in

the sleep quality is twice as much prevalent in population

with migraine as in the general population, which makes it

important to detach that this is a prevalent condition in the

classication of patients with migraine, both by established

relation and by the impact that sleep quality has on quality

of life of these patients.

Body Structures

The outcomes to body structures found were inserted in

the rank “s710 Structure of the region of the head and

of the neck”. It is therefore important to highlight that the

included studies presented measurements that were more

related to the region of the neck than to that of the head,

despite the fact that a migraine is actually a headache.

This phenomenon can be explained by the fact that

migraine’s impact on the head region is very established,

while investigations are on about its impact on the neck

region.

40-42

A previous study assessed the shoulder region, and

some other studies studied the connection of migraine

and structures of the vertebral column and the impact of

other body regions via peripheral sensitization. However,

the small number of researches that have assessed these

outcomes have shown that the major focus of research

remains restricted to the region where the pain occurs.

The allodynia questionnaire is a device that extrapolates

this more local logic of assessment of patients with migraine

and seeks, albeit in a generic way, to identify repercussions

in other body regions. However, in this study, none of the

included studies used this tool, which could have enlarged

the number of categories listed in this component.

Activities and participation

“Activities and participation” is one of the greatest legacies

that the ICF brings to this population classication. The

functioning and disability generated by this sickness are

exactly related to the individual capacity of using a body

(structures and functions) in contact with a determined

environment to execute tasks (activities) inserted in a

specic social context.

This scoping review identied a

large number of outcomes related to this component, which

corroborated with the status of up-to-date art, in that this

is a disabling disease with a high personal and social

impact.

1,45-47

The highest frequency among these categories

was “d850 paid work.” The economic aspect linked to this

category enhances its importance, which explains it being

the most frequent aspect in this component. It was also

necessary to detach that this population prole strengthens

this impact, since the major prevalence of the disease

happens exactly, within the age group economically

active.

48,49

A paper on Brazilian population estimated that >55% of

its population with migraine works in Brazil, while ≥10%

are unemployed and 20% are “housewives” or “students”,

so that almost 85% of the study population can be deemed

to be potentially active.

In addition, absenteeism and decrease in productivity of

people during migraine crises generate costs or income

decit both for themselves and for the market they are

based in, what makes that, especially at this point, migraine

becomes a disease of great impact, both at personal and

social fronts. As a result, migraine can be considered as a

public health problem.

1,6,45

The second-most frequent category was “socializing”. Here

are included denouements related to social functions and

socialization. Despite being generic, the idea they send to,

shows the impact caused by migraine in the social life.

21,31

Then, it becomes important to highlight that researchers

should give greater attention to this rank and this should

be further investigated to obtain more specic outcomes in

the context of socialization of the population with migraine.

Nevertheless, it was also possible to perceive the relation

between migraine and the outcomes linked to the rank

“activities of recreation and leisure,” which revealed that

restriction in these activities directly affects the quality of

life of individuals with migraine.

Thus, it has become imperative that patients’ assessment

not only about this ailment has clinical repercussions,

the professionals who take care of this population need

to pay special attention to social factors affecting these

individuals in the sense of understanding which aspects

of their social life needs improvement as well as rethink

the existing therapeutics to promote entanglement among

clinical objectives and patient’s demands.

6,19

Environmental Factors

As consolidated previously in the literature, the inuence of

environmental factors, especially those concerning crises

triggers in individuals with migraine. In this scope, the most

frequently found outcomes in the articles included “e240

Light” and “e2500 Sound Intensity”. Both of these papers

101

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Feitosa H, Wanderley D, Barros MMMB, Silva SF, Santos AKL, Tenório AS, Oliveira DA

Is it possible to sort the disability of individuals with migraine based on the International Classication of Functioning, Disability and Health? — A Scoping Review

were related to the characterization of samples in relation

to photophobia and phonophobia.

Past studies have demonstrated the relation of migraine

with other triggering factors such as climate change and

cigarette smoking

and have also demonstrated the

relationship of crises triggered by climate changes, which

evidences the importance of being better evaluated in the

relations of migraine with environmental factors in which

individuals such as in the study population are included.

Furthermore, another relevant aspect is that osmophobia

(the fear of smell) is a characteristic that can be present

in individuals with migraine (as described in ICDH-3),

and this point has not received the same attention as

photophobia and phonophobia, which explains the fact

that there is a lack of studies in consideration of this

particular outcome.

2,52

Therefore this research identied two outcomes that have

already been mentioned as important factors in the

disability of the study population. However, this review also

highlights the importance of further studies in this spectrum

to enable the determination of the factors of major impact

in this population so as to seek treatments with better results

for offering them to affected individuals toward creating

environments with major facilitators and no obstacles that

generate limitations and restrictions.

Articles with validated questionnaires

The 59 articles included in this study used validated

questionnaires for the study population and they are

discussed in this special session because it is possible

to measure in the impact generated by migraine in an

individual’s quality of life and disability. Nevertheless,

these studies did not make explicit in which biopsychosocial

aspects the said impact was observed.

From discussing these discoveries, two questions may be

considered relevant: these articles corroborate with those

reported in this review about the deep impact generated

by migraine. It could be conrmed from the perception

of the high scores found in this population through the

questionnaires applied by the found studies.

Nevertheless, it is necessary to detach the importance of a

better clarication of the aspects of a patient’s life that have

been more decisive in these nal scores to adopt a better

approach both in the research and in the clinical environment

for generating a wider and more precise spectrum in the

physical, emotional, and social environment of this population.

Conclusions

This review demonstrated that migraine generates disabilities

related to all of the ICF components; revealed the outcomes

linked to diverse categories of this classication; and also

demonstrated that this impact is broad and affects all areas of

an individual’s life.

Moreover, this review helped recognize the importance of

the previously validated tools for this study population and

their contribution in the measurement of migraine’s impact on

an individual’s quality of life and functioning. However, we

believe that it is necessary to demonstrate, in a broader way,

the aspects of patients’ life that are more affected, both in

their labor activities and leisure, inserted in their own social

context. Thus, the ICF raises an interesting proposal to bridge

this gap for its capability to explain the impacts generated

by migraine over the functioning of the study population in a

universal language.

Funding: The authors did not receive support from any

organization for the submitted work.

Conflicts of interest/Competing interests: The authors don’t

have conicts of interest to declare that are relevant to the

content of this article.

Author contributions: HFS, DAO, collected the data and

paper draft; MMMBB, SFS, AKLS, DW and AST, paper draft

and carried out the review of the nal version.

Hugo Feitosa

https://orcid.org/0000-0003-3247-5310

Débora Wanderley

https://orcid.org/0000-0002-9743-5101

Manuella Morais Monteiro Barbosa Barros

https://orcid.org/0000-0003-4245-7335

Suellen Freitas da Silva

https://orcid.org/0000-0001-8549-5230

Alyne Karine de Lima Santos

https://orcid.org/0000-0003-0845-0113

Angélica da Silva Tenório

https://orcid.org/0000-0002-7066-9047

Daniella Araújo de Oliveira

https://orcid.org/0000-0003-1187-0223

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