Primary headache disorders in the adult general population of Pakistan – a cross sectional nationwide prevalence survey

Abstract

BackgroundThe large geographical gaps in our knowledge of the prevalence and burden of headache disorders include almost all of Eastern Mediterranean Region (EMR). We report a nationwide population-based study in Pakistan, an EMR country with the sixth largest population in the world, conducted as a project within the Global Campaign against Headache.MethodsWe surveyed six locations from the four provinces of Pakistan: Punjab, Sindh, Khyber Pakhtunkhwa and Baluchistan. We randomly selected and visited rural and urban households in each. One adult member (18–65 years) of each household, also randomly selected, was interviewed by a trained non-medical interviewer from the same location using a previously-validated structured questionnaire translated into Urdu, the national language. We estimated 1-year prevalences of the headache disorders of public-health importance and examined their associations with demographic variables using multivariate analysis.ResultsThere were 4223 participants (mean age 34.4 ± 11.0 years; male 1957 [46.3%], female 2266 [53.7%]; urban 1443 [34.2%], rural 2780 [65.8%]). Participation proportion was 89.5%. Headache in the previous year was reported by 3233 (76.6% [95% CI: 75.3–77.8%]). The age- and gender-adjusted 1-year prevalence of migraine was 22.5% [21.2–23.8%] (male 18.0% [16.8–19.2%], female 26.9% [25.6–28.2%]), of tension-type headache (TTH) 44.6% [43.1–46.1%] (male 51.2% [49.7–52.7%], female 37.9% [36.4–39.4%]), of probable medication-overuse headache 0.7% [0.5–1.0%] (male 0.7% [0.5–1.0%], female 0.8% [0.5–1.1%]) and of other headache on ≥15 days/month 7.4% [6.6–8.2%] (male 4.4% [3.8–5.0%], female 10.4% [9.5–11.3%]). Migraine was more prevalent in females by a factor of 3:2 although this association barely survived (P = 0.039) after correcting for other factors. TTH was more prevalent in males by about 4:3 (P = 0.026). All headache and migraine were age-related, peaking in the age group 40–49 years; TTH peaked a decade earlier. Higher education (P = 0.004) and income (P = 0.001) were negatively associated with prevalence of migraine.ConclusionWith three quarters of its population affected, headache disorders must be on the public-health agenda of Pakistan. Worldwide, these disorders are the third leading cause of disability; information from specific enquiry into the burden attributable to headache disorders in this country is needed to inform health policy and priority-setting, and will be reported soon.

Migraine and Headache Prevalence and Associated Comorbidities in a Large Saudi Sample

“…Another finding in our study, consistent with findings in different parts of the world, is that higher income was associated with significantly less MH [13, 38]. …”

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

“…Mean age of the sample was 32.2 ± 10.7 years, with progressive under-representation of age groups above 35 years ( Table 1). Although age distribution within the sample also reflected distortions within the population [20,21], differences were again significant overall. Since gender and age both influence headache prevalence, we adjusted observed values for these.…”

“…Males in the sample (62.3%) considerably outnumbered females (37.7%). To a large extent this reflected the gender distribution of the population, distorted by > 30% of immigrant workers who are mostly male [20,21], but the sample was significantly different from the population according to 2010 census data [20] (Table 1). Mean age of the sample was 32.2 ± 10.7 years, with progressive under-representation of age groups above 35 years ( Table 1).…”

“…This was difficult to arrange when the initial engagement was by cell-phone, and risked selection of a highly biased sub-samplethose with particularly troublesome headache. It was attempted, but abandoned, since the questionnaire had a record of successful use in many countries and cultures [14][15][16][17][18][19][20] and had been validated in four of these [14-16, 20, 26].…”

“…Lifting The Burden (LTB), conducting the Global Campaign against Headache [9][10][11][12], has since been supporting a series of population-based studies to fill these gaps [13][14][15][16][17][18][19][20]. Since there were, in 2007, no data on headache from the whole of the Eastern Mediterranean Region (EMR) [1], these studies have included Pakistan [20], an EMR country with the sixth largest population in the world. Pakistan, however, characterised by economic and political instability and, in parts, by geographical inaccessibility, cannot be considered typical of the Region, which includes the Arab Gulf countries and many in North Africa, from which Pakistan differs ethnically and culturally.…”