Prevalence of Migraine Headache in Saudi Arabia: A Systematic Review and Meta-Analysis

Saudi clinical practice guidelines for the treatment and prevention of migraine headache

OBJECTIVE

To develop clinical practice guidelines based on evidence based medicine on the use of abortive and preventive therapies for managing migraine headaches. We formulated these guidelines to offer evidence-based recommendations to improve the knowledge of physicians, healthcare professionals, and policymakers in migraine headache management.

METHOD

A panel of 11 experts from different sectors in Saudi Arabia approved 26 questions on abortive and preventive therapies for migraines. To develop each question, we searched "PubMed" and "Cochrane Library" databases for recent relevant systematic reviews published between 2013 and 2024. We employed the Grading Recommendations, Assessment, Development, and Evaluation methodological approach to ensure the certainty of the collated evidence and to formulate the recommendations. The expert panel voted electronically on each recommendation, and a consensus was defined as >70% agreement.

RESULTS

We formulated a total of 26 recommendations. Of these, 14 are focused on abortive therapy for acute migraine attacks, whereas 12 are focused on the prevention of episodic or chronic migraines. These guidelines strongly recommend the use of paracetamol and ibuprofen as the first-line treatment for mild to moderate migraine. Furthermore, we concluded that propranolol should be considered as the first-line preventive intervention for migraine.

CONCLUSION

The Saudi clinical practice guidelines offer systematically validated recommendations of migraine headaches in adults. The recommendations are potentially beneficial for all healthcare professionals managing patients with migraine headaches.

Burden of hidden migraine among the Arab general population: a cross-sectional study

BACKGROUND

Migraine is a common type of primary headache which is responsible for one-third of the headache cases. It's also considered the third highest neurological disease with disability in 2021, however, underdiagnosis of migraine remains a significant health problem. This study aims to assess the prevalence of hidden migraine identified by screening among the Arab general population, describe the characteristics of headache attacks, and assess disability and distress associated with migraine.

METHODS

This cross-sectional study was conducted between April and June 2024 among the general population of eight Arab countries using a self-administered online questionnaire to collect sociodemographic data and medical history. The questionnaire also included the ten-item Kessler Psychological Distress Scale (K10), Migraine Screen Questionnaire (MS-Q), and Migraine Disability Assessment Questionnaire (MIDAS).

RESULTS

A total of 2152 individuals completed the questionnaire with a median age of 24 (21-29). Among them 683 (31.7%) individuals were screened positive by MS-Q. Using regression analysis, the independent predictors for positive screening were being Saudi Arabian, having one or more diseases, and having severe psychological distress with adjusted odds ratios of 0.622, 0.282, and 1.329 respectively. Among positive cases, 667 (97.7%) reported having headaches in the past 3 months. Phonophobia (50.97%) and photophobia (49.33%) were the most common associated symptoms. Sleep disturbance (66.72%) and noise (63.87%) were the most common triggering factors while sleep (71.81%) and self-medication (68.52%) were the most common relieving factors. Only 25.34% reported having aura with the last attack. According to MIDAS scores, 459 (67.2%) positive cases had moderate or severe disabilities. Regression analysis identified being a housewife and having one or more diseases as the independent predictors of having moderate or severe disabilities with adjusted odds ratios of 0.228 and 0.523 respectively.

CONCLUSION

Migraine is still underdiagnosed in Arab countries which causes significant disability among positive cases. Raising awareness about the importance of early migraine diagnosis is crucial for encouraging the general population to seek medical advice once they have symptoms.

Prevalence of orofacial and head pain: an umbrella review of systematic reviews

Head pain (HP) and orofacial pain (OFP) are the most prevalent types of pain worldwide, encompassing cranial, oral and facial pain. The aim of this umbrella review was to answer the following questions: "What is the overall prevalence of HP/OFP and the different prevalences of HP/OFP conditions in adults and children?". We searched for studies investigating the prevalence of HP/OFP in four major databases and two databases from the grey literature, based on the following PECOS inclusion criteria: (P)opulation: Adults and children; (E)xposure: Orofacial or head pain conditions such as (1) dental, periodontal and gingival, (2) temporomandibular disorders (TMD), (3) neuropathic conditions, (4) headaches, and (5) idiopathic pain conditions; (C)omparison: None; (O)utcome: Prevalence; (S)tudies: Systematic reviews and/or meta-analyses. We identified 2275 studies and after selection through eligibility criteria, 24 systematic reviews were included. The prevalence of pain in adults for different subgroups ranged from 1.12% for Burning Mouth Syndrome to 80.80% for cancer therapy-related orofacial pain. In children, it ranged from 0.20% for temporomandibular joint osteoarthrosis to 83% for all types of headache. This umbrella review based on available evidence provides integrated data illustrating the highly variable prevalence of head pain and orofacial pain both in adults and children. Considering the high specificity of head pain/orofacial pain, specific public health programs should be developed to address such highly prevalent conditions.

Sexual dysfunction in migraine-affected women: A prospective cross-sectional controlled study

Introduction

Female sexual dysfunction (FSD) is a common health problem that is inadequately investigated in Arabic countries, especially Saudi Arabia.

Aim

To assess the prevalence and trace predictors of FSD in Saudi women who suffered from migraine headaches comparable to healthy women.

Patients and methods

A prospective cross-sectional, controlled study involved 400 Saudi women complaining of migraine (Case Group) and another 400 healthy-looking Saudi women (Control Group) during three months; from January 1st, to March 31st 2023, in Jeddah city, Saudi Arabia. Data was collected by using a pre-structured Female Sexual Function Index (FSFI) questionnaire, Female Sexual Distress Scale (FSDS), Migraine Screen Questionnaire (MS-Q), with an evaluation of the severity of pain by Visual Analogue Scale (VAS), and its impact on daily activity by using both; Headache Impact Test (HIT-6) and Migraine Disability Assessment (MIDAS) Questionnaire.

Results

A total of 800 Saudi women were recruited. Their ages ranged from 18 to 45 years old. Women with abnormally low FSFI scores were 375 (93.75 %) out of 400 with migraine and 85 (21.25 %) out of 400 without migraine. The lowest FSFI scores were mainly for desire (2.75 ± 1.05) and arousal domains (3.0 ± 1.12) followed by sexual satisfaction (3.25 ± 1.30) and orgasmic domains (3.5 ± 1.15). The foremost predictive factor behind low FSFI scores and associated FSD in our study was migraine (P < 0.00001). Additional predictors of statistical significance were low educational level (P < 0.01), urban residency (P < 0.02), high parity (P < 0.02), chronic illness such as diabetes (P < 0.01), and bad habits such as smoking (P < 0.03).

Conclusion

A significant correlation exists between migraine and female sexual dysfunction (FSD). Desire and arousal dysfunctions were the most significantly affected domains followed by satisfaction and orgasmic problems.

The Association Between Shift Work and Migraine Attacks Among Healthcare Workers in the Kingdom of Saudi Arabia

Introduction Migraine, a prevalent condition in Saudi Arabia, is linked to various risk factors, including night shifts. Existing literature, mainly outdated, suggests conflicting findings on the relationship between sleep, night shifts, and migraines. Our study aims to investigate the specific association between shift work and migraine attacks among healthcare workers in the Kingdom of Saudi Arabia (KSA), addressing a notable research gap. Methodology This is a cross-sectional study conducted in Saudi Arabia. Data were collected by using a non-probability convenience sampling technique. Data were collected through an online questionnaire and analyzed using SPSS version 26 (IBM Corp., Armonk, NY). Results Our study on 342 healthcare workers in the KSA revealed the majority of participants were females (70.5%, n = 241), aged between 25 and 29 years (38.9%, n = 133), with doctors being the predominant profession (51.5%, n = 176). Participants had an average of 5.9 years of healthcare experience. Work shifts included rotating (43.3%, n = 148), day (48%, n = 164), evening (3.8%, n = 13), and night shifts (5%, n = 17). Notably, 89.2% (n = 305) experienced headaches with varying characteristics and triggers. Management strategies included over-the-counter painkillers (56.1%, n = 192) and rest (50.5%, n = 173). Gender was significantly associated with migraines (p = 0.020), while night shift frequency and years in health care showed no significant associations. Higher weekly working hours relate significantly to migraines (p = 0.034). Conclusion Our study highlights a significant association between migraines and gender, with females being more prone. Night shift frequency and years in health care showed no significant associations, while higher weekly working hours were linked to migraines.