The relationship between headache and religious attendance (the Nord-Trøndelag health study- HUNT)

A positive relationship between religiousness/spirituality and mental and physical health measures has been demonstrated mainly in cross-sectional studies [1]. Religious activity may be one of several pain coping strategies to manage suffering. This is illustrated by one study reporting that 40% of patients with different types of chronic pain reported that religion and spirituality had become more important in their lives, and that prayer had a beneficial effect on pain tolerance [2].

Headache can severely affect the quality of life and the socioeconomic costs to society [3]. To our knowledge, no previous studies have evaluated the relationship between headache and religious activity using a prospective study design.

The aim of the study was to evaluate whether headache at baseline influenced the occurrence of frequent religious activity at follow-up in a large prospective study.

Demographic and clinical characteristics at baseline in HUNT 2 are given in Table 1 separated by frequency of RA in HUNT 3. Individuals who visited church/prayer house 1–3 times/month or more than 3 times/month were older than those with less frequent visits. For both sexes differences between groups were found regarding e.g. education, depression as measured by HADS, BMI and SBP. Adjustments for all these potential confounding factors were made in the multivariate analyses.

Individuals who suffered from headache at baseline in HUNT 2 were more likely to be fRA at follow-up 11 years later than headache-free (OR = 1.13, 95% CI 1.05-1.22). This relationship was more evident among men (OR = 1.18; 95% CI 1.04-1.34) than women (OR 1.11; 95% CI 1.00-1.22) (Table 2), and more evident for migraine (OR = 1.25; 95% CI 1.19-1.40) than non-migrainous headache (OR = 1.13; 95% CI 1.04-1.23).

As demonstrated by Table 2, having suffered from headache less than 15 days/month at baseline, in particular headache 7–14 days/month, predisposed to being fRA 11 years later (OR = 1.30; 95% CI 1.12-1.52). This relationship was more clearly demonstrated for migraine than non-migrainous headache. Thus, the odds of fRA was 48% increased (OR 1.48; 95% 1.19-1.83) among those with migraine 7–14 days/month at baseline, more evident for women (OR = 1.51; 95% CI 1.11-1.87) than for men (OR = 1.46; 95% CI 1.00-2.23). Individuals with non-migrainous headache < 7 days/month at baseline were more likely to be fRA at follow-up (OR = 1.17; 95% CI 1.07-1.28) than headache-free, evident for men (OR = 1.19; 95% CI 1.02-1.37) but not for women (OR = 1.11; 95% CI 0.99-1.25).

In the multivariate analyses, adjusting for known potential confounders, headache status at baseline did not influence the occurrence of being fSA (Table 3).

In analyses evaluating the influence of headache status in HUNT 2 and HUNT 3, headache complaints in HUNT 2 was more important than headache status in HUNT 3 on the association with fRA (both genders merged, Table 4). Among men those with headache in both surveys were more likely to be fRA (OR = 1.22; 95% CI 1.03-1.44) than headache-free in both surveys. In addition, there was a trend of increasing headache prevalence in HUNT 2 with increasing frequency of RA, evident for both genders merged and for men (Table 5).

To the best of our knowledge, this is the first population-based follow-up study evaluating the relationship between headache and RA, demonstrating that headache, in particular migraine, at baseline slightly increased the likelihood for being fRA 11 years later.

Previous studies evaluating the relationship between headache and RA are lacking. However, it may be of some relevance that a greater reduction in the number of headaches has been found in migrainours who practiced spiritual meditation compared to those practicing secular meditation or muscle relaxation exercises [15]. There are studies reporting that religious activities may be a coping strategy among patients with unspecified chronic pain [16]. In one study, 40% of patients with chronic pain reported that religion and spirituality had become more important in their lives [2]. Furthermore, previous research among older patients with chronic, non-cancer pain have listed analgesic medication (78%), exercise (35%), cognitive methods (37%), religious activities (21%) and activity restriction (20%) as the most common coping strategies [17]. In one small, uncontrolled study among patients with chronic pain secondary to sickle cell disease, church attendance was significantly associated with pain reduction [18]. Private religious activity (prayer/bible study) did, however, not show the same association. When both pain severity and tolerance were assessed, religious coping appeared to increase pain tolerance to a larger degree than the change in pain severity [19]. Interestingly, spirituality has in recent years established its role as a significant modulatory factor of pain transmission [20]. Using a cold pressor stress response test in healthy subjects, blood pressure, pulse and serum cortisol were less increased in religious subjects than in non-religious subjects when exposed to acute painful stress [21]. Further support of stress alleviation includes the association between RA and low blood pressure [22] and between spirituality and lower urinary cortisol excretion in chronic pain patients [23]. An interesting explanation of the association between migraine and RA may be the possibility that spirituality is a way to reduce the allostatic load (biological consequences of chronic exposure to repeated or chronic stress responses) that has been suspected in migraine and other pain conditions [24]. In support of this, weekly religious service attendance has been shown to lower the allostatic load among high-functioning elderly women, using different biomarkers in blood and urine samples [25].

In the present study, headache 1–14 days/month, in particular migraine, was associated with fRA at end of follow-up. A similar tendency was found for migraine >14 days/month, but the level of significance was not met. This may be due to the low number of subjects in these subgroups. An alternative explanation may be that in these subjects the potential benefit of attending RAs is overshadowed by the strain of attending these ceremonies.

A possible explanation of the relationship between headache and fRA could be that headache patients visit church regularly due to access to a social network [26]. On the other hand, no relationship between headache and non-religious social activities was found. Attending church may be a way of coping with the pain, but other mechanisms may also be involved, like predisposing personality traits, underlying genetic susceptibility or other factors. Whether church attendance is the cause of headache or provides relief cannot be definitely determined in this study, but based on the previously mentioned literature on the subject, the latter is most likely.

Stratifying by gender (Table 2), men tended to have higher fRA compared to women. This is an interesting finding as in American research literature women normally are more religious active and also benefit more than men from this activity [26]. The former is also the picture in Norway regarding frequency distribution of RA [4], but women seem to have a kind of a durative approach to religious activity, maintaining the same level of religiousness independent of demanding events and/or illness. Norwegian men, on the other hand, tend to activate religiousness when demanding events and/or illness occur [27, 28].

A relationship between headache at baseline and frequently attaining religious activities was demonstrated in a large population and the association was somewhat more evident for migraine than for non-migrainous headache.