The prevalence of primary headache disorders in Saudi Arabia: a cross- sectional population-based study

DOI: https://doi.org/10.1186/s10194- 020- 1081- 1

Abstract-Summary The large geographical gaps in our knowledge of the prevalence and burden of headache disorders include most of Eastern Mediterranean Region (EMR).

We surveyed Arabic-speaking adults aged 18–65 years in all 13 regions of KSA. While previous Global Campaign studies have engaged participants by calling at

randomly selected households, the culture of KSA made this unacceptable.

We estimated 1-year prevalences of the headache disorders of public-health importance (migraine, tension-type headache [TTH] and probable medication- overuse headache [pMOH]) and examined their associations with demographic variables.

Gender and age distributions imperfectly matched those of the national popula-

tion, requiring adjustments for these to prevalence estimates.

Observed 1-year prevalence of all headache was 77.2%, reducing to 65.8% when

adjusted.

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For headache types, adjusted 1-year prevalences were migraine 25.0%, TTH

34.1%, pMOH 2.0% and other headache on ≥15 days/month 2.3%.

Adjusted 1-day prevalence of any headache was 11.5%. Migraine was negatively associated with age > 45 years (OR: 0.4; p = 0.0143)

while pMOH was most prevalent in those aged 46–55 years (OR: 2.7; p = 0.0415).

Prevalences of migraine and TTH in KSA are considerably higher than global averages (which may be underestimated), and not very different from those in Pakistan.

Extended: We estimated 1-year prevalences, gender- and age-adjusted, of 25.0%

for migraine and 34.1% for TTH.

Introduction Over a decade ago, a systematic review of the published literature found that head- ache disorders affected almost half the world’s population [89].

In various iterations of the Global Burden of Disease (GBD) study, they were shown to be the second and third most common disorders in the world [31] and of clear public-health importance [8, 31, 32, 47–95].

Lifting The Burden (LTB), conducting the Global Campaign against Headache [36, 37, 49–96], has since been supporting a series of population-based studies to fill these gaps [4, 42–100].

Since there were, in 2007, no data on headache from the whole of the Eastern Mediterranean Region (EMR) [89], these studies have included Pakistan [100], an EMR country with the sixth largest population in the world.

We report here a second Global Campaign study from EMR, with prevalence findings of a nationwide cross-sectional population-based survey in the Kingdom of Saudi Arabia (KSA).

All Global Campaign studies so far have followed standardized methodology

developed by LTB [51].

Methods For planning purposes we anticipated a 20% non-participation proportion and a requirement therefore to contact a minimum of 2400 potential respondents (N), drawn from each region in proportion to its population according to the census [101]. Any Arabic-speaking person aged 18–65 years who answered the telephone was

a potential participant.

Each eligible person who agreed upon first contact to participate was included in the survey and, whenever willing, interviewed immediately through the cell- phone call.

The questionnaire had four parts: (a) personal and demographic enquiry (includ- ing gender, age, marital status, educational level, employment and income from all sources), and (b) headache screening questions, which were addressed to all partici- pants; these were followed in those screening positively by (c) diagnostic questions based on ICHD-II [102] and d) enquiry into burden.

Throughout the period of data collection, for fraud-detection purposes, partici- pants were randomly selected and called again, at the rate of approximately 2/week.

1.1

Epidemiology

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Results Since gender and age both influence headache prevalence, we adjusted observed values for these.

1789 participants (77.2% [95% CI: 75.5–79.0%]) reported headache in the pre-

ceding year.

Gender- and age-adjusted 1-year prevalence was 65.8% [63.9–67.7%]. Headache yesterday [HY] was reported by 254 participants (11.0% [9.7–12.2%]). For TTH, the age-relationship was rather flat across all ages, with only a small

peak among those aged 26–35 years.

For pMOH, with small numbers and wide CIs, reported prevalence increased

steadily up to 46–55 years and then declined sharply.

Other headache on ≥15 days/month also declined after 46–55 years, again with

small numbers.

HY was reported more as age increased up to 46–55 years, but this was a non-

significant trend.

Discussion The global age-standardised 1-year prevalence estimates for migraine and TTH, from GBD2016 [8] (which has the most detailed headache analyses), are 14.4% and 26.1%.

In Pakistan the age- and gender-adjusted 1-year prevalence of migraine is 22.5% [95% CI: 21.2–23.8%]; in KSA, at 25.0 [23.2–26.8], it is somewhat higher (Fisher’s exact test: p = 0.0238).

TTH is more prevalent in males in both countries, in Pakistan by about 1.3:1, in

KSA by 1.2:1.

There is a large gender-related difference in pMOH between KSA and Pakistan: while this disorder affects only 0.8% of adults in Pakistan [100], and the same pro- portion of males in KSA, it is reported by 3.4% of females in KSA, making it pre- dominantly a problem among women in this country.

Conclusion Prevalences in KSA of migraine and TTH, and perhaps of pMOH, are considerably higher than global averages.

Prevalences in KSA are not very different from those in Pakistan, also an EMR

country but with many differences otherwise.

Information on the burden attributable to these disorders in KSA, needed to

inform health policy and priority-setting, will be reported later.

Acknowledgement A machine generated summary based on the work of Jumah, Mohammed Al; Khathaami, Ali M.  Al; Kojan, Suleman; Hussain, Mohamed; Thomas, Hallie; Steiner, Timothy J. 2020 in The Journal of Headache and Pain.

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Survival outcome and mortality rate in patients with migraine: a population- based cohort study