Introduction
According to the International Classification of Headache Disorders (ICHD), the most common pain disorder is a headache. The simplest definition of headache based on the criteria for diagnosis and classification by the International Headache Association (2018) is the sensation of pain from the eye to the back of the head. Headaches are classified into two categories: primary and secondary [1]. According to the definition of headache classification criterion (2018), primary headaches are those that occur without any primary cause and are not caused by other complications [2]. According to the classification criteria of primary headache (2018), the most common primary headaches are migraine headaches, tension headaches, and cluster headaches [3]. A review of various studies shows that primary headaches are negatively correlated with the quality of life (QoL), and people with chronic primary headaches experience a lower QoL compared to healthy individuals [8, 9]. One manifestation of positive emotions is the QoL which includes life satisfaction and feelings of happiness and joy. These are the aspects of health [10]. In the research of Malekpour, Marashi and Bashlideh (2017) in designing and testing a model of the antecedents and consequences of migraine headaches, the results showed that low QoL can trigger, aggravate, or perpetuate headache attacks, in addition to the disability and confusion associated with headaches and the change in the patient’s attitude and knowledge about life events and the resulting stress [11]. emotion-focused therapy is a neo-humanistic and experimental method in which the therapist focuses on raising the awareness of the mental content that has been denied or distorted by the therapist and creating new meaning influenced by the client’s physical experience [13]. Timolak and Greenberg (2018) has shown that emotional therapy is effective in the QoL of people with chronic headaches [16] . Gilbert’s (2010) compassionate therapy is based on the evolutionary theory and emphasizes the interaction between threat, motivational, and sedative systems with the neurological subset [17]. Kaltz (2016) argues that a supportive attitude toward self and others is associated with positive psychological consequences, such as reducing negative emotions and increasing physical health [18]. The study by Yarnell and Neff (2017) has shown that compassion-focused treatment helps improve the QoL by reinterpreting events through forgiveness and empathy [20]. By combining the content of these two treatments, the background for using and exploiting the strengths and empowerment of both approaches to increase the well-being and emotional and mental health of patients can be provided. This combination therapy seeks to promote adaptive and positive coping strategies to further improve the quality of life of patients with early headache symptoms. Therefore, the present study seeks to answer two main questions: 1) what effects does the combination of compassion-based emotion therapy and compassion-focused treatment have on the quality of life of patients with primary headache symptoms? 2) Do these two methods of intervention lead to different results in terms of effectiveness?
Methods
This is a three-group quasi-experimental study with a pre-test-post-test design and follow-up with a control group. The statistical population include all patients with primary headache symptoms who were referred to the clinic of Khatam Al-Anbia Hospital in Tehran in the winter of 2020. The population was in the age range of 18 to 45 years, from which 45 patients were purposefully selected. After the purposeful selection of the sample members, the randomly selected individuals (lottery) were divided into 3 groups of 15 people (in a quasi-experimental study, at least 15 people are recommended for each group). Then, subjects were divided into two experimental groups and one control group after sampling. After collecting the data, they were entered into the SPSS software, v. 24, and descriptive statistics (including mean and standard deviation) and inferential statistics (including repeated measures analysis of variance and the Bonferroni post hoc tests) were used to analyze the data.
Results
In the intragroup effect section, the time factor (F=3.47, df=1.15 and P>0.05) and the interaction of the time and group factor (F=8.25, df=2.31 and P<0.01), there is a significant difference (P<0.01) in the QoL between pre-test, post-test, and follow-up and time interaction with the group (three research groups) (Table 1).


The Bonferroni test results show the quality of life in the post-test phase, compassionate emotion-based integrated therapy group, and the compassion-focused treatment group are significantly different from the control group (P<0.01), Also, no significant difference was observed in the quality of life in the follow-up phase in the treatment group or the control group (P>0.05). 
Discussion 
This study aimed to compare the effectiveness of compassionate emotion-based integrated therapy and compassion-focused treatment on quality of life in patients with primary headache symptoms [19, 20]. The discussion showed that these two treatments significantly increased the quality of life in patients with primary headache symptoms. The research conclusion shows that compassionate emotion-based integrated therapy for patients with primary headache symptoms can create more awareness and acceptance of thoughts and feelings and the use of positive strategies (Table 1).
Compassion-based emotion therapy helps patients with early headache symptoms while positively regulating emotions, accepting their present and past experiences as they are and without judgment, thus changing their quality of life (such as motivation), increasing their satisfaction, and understanding of public health.

Ethical Considerations
Compliance with ethical guidelines
Maintaining the principle of complete confidentiality for participants; Having full authority to withdraw from the research; Obtain written consent; Using data for research purposes

Funding
This research is a part of Neda Behandi's PhD thesis as the first author , which was carried out in collaboration with Folor Khayatan as a supervisor and Mohsen Golparvar as a consultant. This research was not financially supported.

Authors contributions
Conceptualization: Neda Behvandi; Methodology: Folor Khayatan, Mohsen Golparvar; Investigation: Neda Behvandi, Felor Khayatan; Writing-Original Draft:  Neda Behvandi; Writing-Review & Editing: Neda Behvandi, Felor Khayatan; Resources: Neda Behvandi, Felor Khayatan; Supervision: Neda Behvandi, Folor Khayatan, Mohsen Golparvar.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
We would like to thank all the participants and officials of Khatam Al-Anbia Hospital who cooperated with us in carrying out this research.


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