Cross-sectional, hospital-based analysis of headache types using ICHD-3 criteria in the Middle East, Asia, and Africa: the Head-MENAA study

Abstract

Background Headaches are frequent neurological disorders that are yet to be unveiled and treated comprehensively worldwide. Bearing in mind that the distribution of headache subtypes in neurology clinics (NC) is essential for planning appropriate diagnostic and therapeutic approaches, the primary goals of this multi-centric study are to carry out inter-regional comparisons by using current diagnostic criteria with evaluations of neurologists to delineate headache burden. Methods A cross-sectional study between April 1 and May 16, 2022 was conducted with the participation of 13 countries from the Middle East, Asia, and Africa. Patients were included in the study on a specific day each week during five consecutive weeks. All volunteers over the age of 18 and whose primary cause for admission was headache were examined. The patients admitted to NC or referred from emergency services/other services were evaluated by neurologists by means of the International Classification of Headache Disorders (ICHD-3) criteria. Results Among the 13,794 patients encountered in NC, headache was the primary complaint in 30.04%. The headache patients’ mean age was 42.85 ± 14.89 (18–95 years), and 74.3% were female. According to the ICHD-3 criteria, 86.7% of the main group had primary headache disorders, 33.5% had secondary headaches, 4% had painful cranial neuropathies along with other facial and headaches, and 5.2% had headaches included in the appendix part showing some overlapping conditions. While the most common primary headache was migraine without aura (36.8%), the most common secondary headache was medication-overuse headache (MOH) (9.8%). Headaches attributed to COVID-19, its secondary complications, or vaccines continue to occur at rates of 1.2%-3.5% in current neurology practice. Pain severity was significantly lower in Ivory Coast and Sudan than in Türkiye, Turkish Republic of Northern Cyprus, Iran, Egypt, Senegal, Tatarstan, and Azerbaijan (p < 0.001). Conclusions The study showed that migraine is still the most common motive for admissions to NC in different regions. Furthermore, MOH, an avoidable disorder, is the most common secondary headache type and appears to be a significant problem in all regions. Remarkably, pain perception differs between regions, and pain intensity is lower in Africa than in other regions.

Secondary headache disorders in Turkey, the Middle East, Asia, and Africa: A cross-sectional, multicenter study

“…Pain severity, as measured using an NRS, was different between the regions (p ¼ 0.002). In pairwise comparisons, it was observed that the patients in Africa (6.37 AE 2.14 [range, [3][4][5][6][7][8][9][10]) presented to the hospital with milder pain than those in Turkey (6.96 AE 0.09 [range, 1-10]), the Middle East (6.87 AE 0.30 [range, 2-10]), and Asia (6.86 AE 0.27 [range, 5-9]) (p ¼ 0.047). The density of headaches (the number of days with headache per month) was different between the regions (p < 0.001).…”

“…The density of headaches (the number of days with headache per month) was different between the regions (p < 0.001). In pairwise comparisons, it was detected that the patients in Africa (5.93 ± 1.06 [0–30]) referred to the hospital with a lower density of headaches than those in Turkey (11.68 ± 0.53 [0–30]), the Middle East (15.97 ± 1.73 [2–30]), and Asia (11.19 ± 2.15 [0–30]) (p < 0.001) (Figure 4).…”

“…The present cross-sectional multicenter study was conducted using the Head-MENAA protocol (8). Patients were admitted to the study on a particular day each week for five consecutive weeks between 1 April and 16 May 2022.…”

Virtual dynamic interaction games reveal impaired multisensory integration in women with migraine

“…16 This interaction between the hypersensitivities of patients with migraine is thought to result from the activation of cortical areas involved in modality upon visual stimuli in the fourth, seventh, and tenth rounds (median [IQR] 78. 1…”

The prevalence and associated factors for primary headache disorders in adolescents in eastern Sudan: a community-based cross-sectional study

“…Recent reports in the Middle East, Asia, and Africa have shown that the prevalence of headache among adolescents is almost similar to that among adults; however, the epidemiology of headache is less investigated among adolescents than adults ( 2 ). Primary headache disorders among children and adolescents are a worldwide health problem ( 3 , 4 ).…”