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      The Epidemiology of Migraine Headache in Arab Countries: A Systematic Review

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          Abstract

          Background

          Recurring migraine disorders are a common medical problem, standing among the top causes of disability and sufferings. This study aimed to evaluate epidemiological evidence to report updated estimates on prevalence, risk factors, and associated comorbidities of migraine headache in the Arab countries. Design and Setting. A systematic review was conducted at the College of Public Health and Health Informatics, Riyadh, Saudi Arabia.

          Methods

          A systematic search in electronic databases, such as PubMed and Embase, as well as manual searches with cross-referencing was performed from 1990 up to 2019. Overall, 23 included papers were rated independently by two reviewers. Studies were eligible for inclusion only if they investigated migraine headache epidemiology in any Arab country and were published in English.

          Results

          Migraine prevalence among the general population ranged between 2.6% and 32%. The estimated prevalence of migraine headache among medical university students ranged between 12.2% and 27.9% and between 7.1% and 13.7% in schoolchildren (6 to 18 years). Females were found more likely to have migraine than males. The duration of migraine attacks became shorter with increasing age, while chronic (daily) migraine showed increasing prevalence with age. The most commonly reported comorbidities with migraine included anxiety, hypertension, irritable bowel syndrome, and depression. Most common headache-triggering factors included stress, fatigue, sleep disturbances, prolonged exposure to excessive sunlight or heat, and hunger.

          Conclusion

          The prevalence and risk factors of migraine headache in Arab countries are comparable to reports from western countries. Longitudinal studies are still needed to investigate the prognosis and predictors of chronicity in the arab countries.

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          Most cited references51

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          Migraine affects 1 in 10 people worldwide featuring recent rise: A systematic review and meta-analysis of community-based studies involving 6 million participants.

          To study the weighted average global prevalence of migraine at the community level.
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            Migraine pathophysiology: lessons from mouse models and human genetics.

            Migraine is a common, disabling, and undertreated episodic brain disorder that is more common in women than in men. Unbiased genome-wide association studies have identified 13 migraine-associated variants pointing at genes that cluster in pathways for glutamatergic neurotransmission, synaptic function, pain sensing, metalloproteinases, and the vasculature. The individual pathogenetic contribution of each gene variant is difficult to assess because of small effect sizes and complex interactions. Six genes with large effect sizes were identified in patients with rare monogenic migraine syndromes, in which hemiplegic migraine and non-hemiplegic migraine with or without aura are part of a wider clinical spectrum. Transgenic mouse models with human monogenic-migraine-syndrome gene mutations showed migraine-like features, increased glutamatergic neurotransmission, cerebral hyperexcitability, and enhanced susceptibility to cortical spreading depression, which is the electrophysiological correlate of aura and a putative trigger for migraine. Enhanced susceptibility to cortical spreading depression increased sensitivity to focal cerebral ischaemia, and blocking of cortical spreading depression improved stroke outcome in these mice. Changes in female hormone levels in these mice modulated cortical spreading depression susceptibility in much the same way that hormonal fluctuations affect migraine activity in patients. These findings confirm the multifactorial basis of migraine and might allow new prophylactic options to be developed, not only for migraine but potentially also for migraine-comorbid disorders such as epilepsy, depression, and stroke.
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              Epidemiology of headache in Europe.

              The present review of epidemiologic studies on migraine and headache in Europe is part of a larger initiative by the European Brain Council to estimate the costs incurred because of brain disorders. Summarizing the data on 1-year prevalence, the proportion of adults in Europe reporting headache was 51%, migraine 14%, and 'chronic headache' (i.e. > or =15 days/month or 'daily') 4%. Generally, migraine, and to a lesser degree headache, are most prevalent during the most productive years of adulthood, from age 20 to 50 years. Several European studies document the negative influence of headache disorders on the quality of life, and health-economic studies indicate that 15% of adults were absent from work during the last year because of headache. Very few studies have been performed in Eastern Europe, and there are also surprisingly little data on tension-type headache from any country. Although the methodology and the quality of the published studies vary considerably, making direct comparisons between different countries difficult, the present review clearly demonstrates that headache disorders are extremely prevalent and have a vast impact on public health. The data collected should be used as arguments to increase resources to headache research and care for headache patients all over the continent.
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                Author and article information

                Contributors
                Journal
                ScientificWorldJournal
                ScientificWorldJournal
                TSWJ
                The Scientific World Journal
                Hindawi
                2356-6140
                1537-744X
                2020
                16 June 2020
                : 2020
                : 4790254
                Affiliations
                1College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
                2King Abdullah Specialist Children's Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
                3Princess Nourah Bint Abdulrahman University, King Abdullah Bin AbdulAziz University Hospital, Riyadh, Saudi Arabia
                4King Abdulaziz Medical City, National Guard Health Affairs, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
                5King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
                6King Abdulaziz Medical City, National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
                7Dow University of Health Sciences, Karachi, Pakistan
                8Ministry of Health, Riyadh, Saudi Arabia
                Author notes

                Academic Editor: Noureddin Nakhostin Ansari

                Author information
                https://orcid.org/0000-0001-5575-0077
                https://orcid.org/0000-0002-5992-6807
                https://orcid.org/0000-0002-4736-1917
                Article
                10.1155/2020/4790254
                7315321
                32607079
                8bfb433f-19c0-4ce8-9d45-876f960e2940
                Copyright © 2020 Ashraf El-Metwally et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 January 2020
                : 8 May 2020
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