ISSN 2171-6625 Journal Of Neurology And Neuroscience .
Research ArticleiMedPub Journalswww.imedpub.comJournal of Neurology and NeuroscienceISSN 2171-66252020Vol.11 No.1:313DOI: 10.36648/2171-6625.11.1.313Migraine in Adult Saudi Population: Exploring Common Predictors, Symptomsand Its Impact on Quality of LifeSadiqa Syed*, Shabina Farid Shapo, Jawaher Jazaa Al-Otaibi, Mashaeel Hamad Almutairi, MayaTarek Mohideen and Banan Azem KhedrCollege of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, KSA, Saudi Arabia*Correspondingauthor: Sadiqa Syed, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, KSA, Saudi Arabia, Tel:00966556256526; E-mail: sasyed@pnu.edu.saReceived date: November 26, 2019; Accepted date: February 07, 2020; Published date: February 14, 2020Citation: Syed S, Shapo SF, Al-Otaibi JJ, Almutairi MH, Mohideen MT, et al. (2020) Migraine in adult Saudi population: Exploring commonpredictors, symptoms and its impact on Quality of Life. J Neurol Neurosci Vol.11 No.1: 313.AbstractPurpose of study: Migraine is the commonest type ofheadache, affecting 12% Saudi population. Disparities inpresenting symptoms and predictors lead to improperdiagnosis and treatment of this condition having anegative impact on quality of life. The main objective is toexplore the common predictors and symptoms ofmigraine affecting adult Saudi population and to assess itsinfluence on their quality of life.Methods: A cross sectional study was conducted on 500subjects suffering from migraine, aged between 18-55years. A self-administered questionnaire was used toassess the objectives, comprising demographic data,symptoms and predictors related to migraine and theeffect of migraine on the quality of life. Data was collectedfrom students of different colleges, males and femalesfrom shopping malls and parks etc. representing generalSaudi population. The data was analysed by SPSS version21; Chi-square test was applied for comparison andPearson's correlation assessed to evaluate impact onquality of life.Results: Majority of participants were females, agedbetween 18-35 years, belonging to higher income groupand with higher education level. The associatedsymptoms included vertigo in 74.4% subjects followed bynausea (67.9%). The predictors were chiefly lack of sleep,exam stress and hunger in 88%, 67.2% and 68.5% subjectsrespectively. A positive correlation was found betweenseverity of symptoms and worsening of quality of life (pvalue 0.04).Conclusion: Severity of symptoms was accompanied bypoor quality of life in terms of social and professionalaspects. There was a lack of awareness in majority ofsubjects about migraine leading to underdiagnoses, undertreatment and with high use of over the countermedications. There is a need for proper awarenesscampaigns in Saudi population. Copyright iMedPub This article is available from: www.jneuro.comKeywords: Migraine; Predictors; Aura; Saudi population;Quality of lifeIntroductionMigraine is a common disorder causing attacks ofneurological dysfunction and pain [1]. It is a unilateral/pulsating headache, diagnosed on the basis of at least fiveattacks lasting for 4-72 hours and accompanied by nausea,vomiting, photophobia or phonophobia; the symptoms notattributed to any other disorder [2,3].Migraine affects over 20% of world population at somepoint in their lives. Epidemiological studies have shown that4.5% of the Western European population has headache atleast 15 days per month [4] whereas prevalence is 14.2% inUSA adults [5], 1-22% in Asian countries [6] and 12.1% in SaudiArabia [7]. Moreover, prevalence is strikingly higher amongfemales compared to males (17.3%: 5.7%) [8].Migraine is of two main types, episodic (EM) and chronicmigraine (CM); individuals diagnosed with EM experience 0-14headache days per month, while those with CM mostlyexperience more than 15 episodes per month for 3 months.Although they both share almost the same risk factors, theydiffer in epidemiology, symptoms, disabilities and ways oftreatments [9] as documented by three large observationalstudies: The International Burdens of Migraine Study (IBMS)[10], The American Migraine Prevalence and Prevention(AMPP) [11] and the German Headache Consortium (GHC)”.Global studies suggest that CM imposes substantial economicburden on society [9], and is generally costlier than EM, due tomore hospital and specialist’s visits compared to EM, and ismore associated with comorbidities such as vascular diseasesand psychiatric disorders [12].The pain of migraine is typically supplemented by aconstellation of warning signs such as nausea, dizziness,extreme sensitivity to light etc. Additionally, about 20% ofmigraine sufferers experience visual aura, usually before theheadache starts [13], comprising floaters, flashes of light, zigzag patterns etc. Approximately 10-20% of migraineursexperience premonitory symptoms up to 48 hours before1
Journal of Neurology and Neuroscience2020ISSN 2171-6625attack [14] including fatigue, abnormal bursts of energy, neckstiffness, yawning and frequent urination [15].To trigger an attack of migraine, many potential causes havebeen suggested, including hormonal, emotional, physical,dietary, environmental and medicinal factors. These triggersvary in different individuals and sometimes it is difficult toidentify whether it is a cause or effect of a migraine attack[16]. Cyclical hormonal changes in women due to fluctuationsin estrogen level seem to trigger headaches in many women[17], as majority of them report headaches immediatelybefore or during their menstrual periods, while others developmigraines during pregnancy or menopause. Hormonalmedications, such as oral contraceptives and hormonereplacement therapy, may also worsen migraines, nonethelesssome women find their migraines occurring less often whiletaking these medications [18].Intake of caffeinated drinks, alcohol, salty and processedfoods, as well as skipping meals or fasting can also triggerthese attacks [19,20]. Stress, anxiety and depression at workor home and disturbances in sleep pattern and meal time orlack of sleep (less than 7-9 hours) can cause migraines. Sensorystimuli, bright lights, sun glare and strong smells can inducemigraines besides loud sounds [21]. Medications likevasodilators, such as nitroglycerin, can also aggravate migraine[22].Frequency of migraine affects the health-related quality oflife (HRQoL) in physical, social and mental dimensions [23].Many patients with migraine experience reduced productivityand decision making at work and disruption of their family,social, and leisure activities [24].Migraine is a common disabling disorder with a higherprevalence in Saudi Arabia, affecting people's productivity, yetthere is a lack of awareness regarding symptoms andpredictors of migraine. This study was planned to investigatethe common triggers and lifestyle behaviors causing migraine,and to study its effect on the HRQoL in adult Saudi populationwho is socially and culturally different from other countries.MethodsQuestionnaireThe study was based on a structured, closed-endedquestionnaire comprising a total of 16 items. It comprisedthree portions: the first part included personal informationand demographic data (Table 1). The second part containedfive questions related to causes and characteristics ofmigraine. These questions were selected from Headachequestionnaire prepared by Cleveland Clinic Canada fordiagnosis of migraine. The responses in this part wereaffirmative (yes) or negative (no) and were numberedaccordingly. The third part comprised eleven questions relatedto impact of headache on the HRQoL, in terms of handlingroutine house-hold chores, canceling work/social activities,feeling less energetic, tired and frustrated, dealing with familyand friends, and lacking focusing abilities etc. These questionshave been selected from Glaxo questionnaire, used in manypublished studies. The responses were measured on a fourpoint scale starting from “none of the time, some of the time,most of the time and all of the time” and were numbered oneto four. There were no negative questions.Table 1: Demographic data of Study settingColleges of Princess Nourah Bint Abdulrahman University,shopping Malls, Coffee shops, hospital patients and theirrelatives in Riyadh, Saudi Arabia. Data was collected fromSeptember to December 2018.Study subjectsIt includes adult Saudis of both genders between the ages of18-55 year. Children less than 18 years and elderly peoplemore than 55 years of age were excluded; also, patients withneurological diseases as well as Non-Saudis were omitted.Study designIt is a cross sectional study.2Vol.11 isfactory16736.3Not enough, indebt7716.7Enough, save21647monthlySince, the questions were selected from two differentquestionnaires, so the content validity and internal consistencywere tested through a pilot test by distributing thisquestionnaire to twenty subjects and calculating the Cronbachalpha.The questionnaire was translated in Arabic language tofacilitate the Non-English-speaking participants and then backto back translated.The questionnaires were distributed manually among theparticipants according to the criteria of InternationalThis article is available from: www.jneuro.com
Journal of Neurology and Neuroscience2020ISSN 2171-6625Vol.11 No.1:313Headache Society Classification (IHSC,2013) by the membersof the Research team.which reflects that more severe the symptoms, poorer thequality of life (Table 3 and Figure 1).Sample sizeTable 2: Symptoms associated with migraine in Saudipopulation.Previous literature showed that the prevalence of migrainein Saudi Arabia is 12.1 (0.12), using level of confidence 95%(alpha 0.05), power of study of 80% (beta 20%), difference of( 0.05) in G power program, the minimal sample size forcurrent study was calculated to be 392. To compensate forincomplete responses of questionnaire, a total of 500 samplesof Questionnaires were distributed.Sampling techniquePurposive and snowball sampling were used to approachthe subjects who were suffering from migraine. Participantswere chosen according to the criteria of IHSC.ResultsA total of 500 questionnaires were distributed to subjectscomplaining of migraine. There were six incomplete responses,whereas 34 subjects who did not fulfil the criteria of migraine(having only aura without headache) were excluded. A total of460 responses who fulfilled the criteria for migraine accordingto IHSC were thus finalized for statistical analysis.Gender-wise the participants comprised 33 (7.2%) males,and 427 (92.8%) females; while age-wise there were 407(88.5%) subjects in 18-35 age group and 53 (11.5 participants%) in 36-55 age group.Regarding the education level, majority of participants(67.6%) had higher education (bachelor, master etc.), while theleast belong to primary education level (2.8%). The averagemonthly income was satisfactory in 167 (36.3%) participants,while most participants have enough income (47%).Among the occupations, majority of participants werestudents (323: 70.2%), whereas 95 (20.7%) were employed,and 41 (8.9%) were unemployed including mostly housewives.Regarding the symptoms of migraine, 303 (74.4%) subjectshad complaint of vertigo in age category 18-35 and 36 (67.9%)subjects complained of nausea in age category 36-55 years.Also, 299 (68%) participants did not visit the doctor for theirsymptom while only 160 (34.8%) visited the doctor. Out ofthem 144 (40.2%) took their medication to relieve theirsymptom whereas 214 (59.8%) took over the countermedication without visiting the doctors (Table 2).Most of our participants in all age categories relieved theirsymptoms by either taking medications (77.8%) or resting in aquiet place (78.5%). Moreover, the commonest cause of lifestyle behavior causing migraine was lack of sleep in (88%)cases, followed by stress of exams (67.2%) and prolongedhunger (68.5%). Finally, the migraine has badly affected thequality of life in both age categories (56.7%); thus there was apositive correlation between severity of symptom andworsening of quality of life (correlation coefficient 0.04) Copyright iMedPubAge category in years (percentage)pvalueSymptoms18-3536-53Flash of light153 (37.6)18 (34)0.6Nausea230 (56.3)36 (67.9)0.04*Blurred vision182 (44.7)29 (54.7)0.1Tingling120 (29.5)21 (39.6)0.1Speech disturbances126 (31)8 (15.1)0.1Vomiting107 (26.3)21 (39.6)0.1Light sensitivity231 (56.8)33 (62.300.4Vertigo303 974.4)29 (54.7)0.03*(*) SignificantDiscussionMigraine, despite having a higher prevalence in young adultSaudi population (12%), is frequently underdiagnosed andundertreated. Our study reported that episodic migraine is thecommonest headache occurring in younger age group,predominantly in women. This finding is consistent with manystudies documenting that migraine is experienced mostly atyoung age, among 20% of women and 10% men [13,25]. Thefemale gender predominance may be attributed to the role ofestrogen acting as a key factor in the increased prevalence ofmigraine in women [26].Interestingly, our study showed a positive correlationbetween migraine and higher educational level as well assatisfactory monthly income. On the contrary, a recent studyconducted in India showed that migraine was more common inpatients with lower educational level and lower monthlyincome [27].Regarding associated symptoms, an overwhelming majorityof our participants did not experience aura whereas vertigowas the commonest symptom observed in a clear majority,followed by nausea. On the other hand, a study done in theUSA reported vertigo to be experienced by a much lowerproportion of migraineurs [8]. Furthermore, another studyshowed that half of the overall migraine participants reportedhigh frequency of nausea (greater than 50% of the time) andthere were no differences related to age, income or populationsize [27].Among the triggers of migraine, our study determined thatlack of sleep is the most common cause of migraine, followedby stress of exams and hunger. Other studies endorsed ourfindings that sleep disturbances may predispose individuals tomigraine attacks [28]. Taking medications and resting in quiet3
Journal of Neurology and NeuroscienceISSN 2171-66252020Vol.11 No.1:313place were main relieving factors in our study which isconsistent with other studies.Table 3: Comparison of demographic variables and quality of life with severity of ity of .90%48.40%9.70%Bad22.70%51.60%25.80%p value0.5820.450.1370.4480.000*positive correlation between the severity of symptoms andpoorer quality of life, with a great majority being unable toconcentrate on work or daily activities, having tiredness,frustration and interferences with leisure time activities.Multiple studies display the burden of migraine on the qualityof life on both the social and the economic aspects. A studyconducted in USA showed that majority of participants havemissed work or schedule, cancelled social events, were lessproductive at work or school, and skipped their householdchores [5].ConclusionFigure 1: Pearson's correlation between symptom ofmigraine and quality of life (Correlation coefficient 0.04).A significant finding of our study was low level of selfawareness about symptoms and predictors of migraine.Majority of participants were unaware that they weresuffering from migraine and were eventually using selfmedications to relieve their headaches without consulting aphysician. A study done on German population alsodocumented low self-awareness and medical recognition ofmigraine [29].Concerning the effects of migraine on the social andprofessional aspects of quality of life, both sexes but theyounger age group was most negatively affected. There was a4It is recommended that awareness related to knowledge ofsymptoms and triggers of migraine among general Saudipopulation be raised by print and electronic media as well asprinted brochures should be placed in every health carecenter. Time and stress management courses and relaxationsessions to improve productivity among migraineurs shouldalso be arranged.Limitation of Study PopulationThe study sample belonged to Riyadh, the capital of SaudiArabia which has a higher education and income level.References1.Slavin M, Ailani J (2017) A clinical approach to addressing dietwith migraine patients. Curr Neurol Neurosci Rep 17: 17.2.Headache Classification Committee of the InternationalHeadache Society (IHS) (2013) The international classification ofheadache disorders, (beta version). Cephalalgia 33: 629-808.This article is available from: www.jneuro.com
Journal of Neurology and NeuroscienceISSN 2171-66252020Vol.11 No.1:3133.Breedveld AC, Rovers JM, Vermeiden JP, Witteman BJ, Smits MG(2014) Migraine associated with gastrointestinal disorders: Areview of the literature and clinical implications. Front Neurol5:241.16. Ibrahim NK, Alotaibi AK, Alhazmi AM, Alshehri RZ, Saimaldaher4.Welch MK, Goadsby PJ (2002) Chronic daily headache: Nosologyand pathophysiology. Curr Opin Neurol 15: 287-295.17. Sutherland HG, Champion M, Plays A, Stuart S, Haupt LM, et al.5.Burch R, Rizzoli P, Loder E (2018) The prevalence and impact ofmigraine and severe headache in the United States: Figures andtrends from government health studies. Headache 58: 496-505.6.Stovner LJ, Hagen K, Jensen R, Katsarava Z, Lipton RB, et al.(2007) The global burden of headache: a documentation ofheadache prevalence and disability worldwide. Cephalalgia 27:193-210.RN, et al. (2017) Prevalence, predictors and triggers of migraineheadache among medical students and interns in King AbdulazizUniversity, Jeddah, Saudi Arabia. Pak J Med Sci 33: 270.(2017) Investigation of polymorphisms in genes involved inestrogen metabolism in menstrual migraine. Gene 607: 36-40.18. Vetvik KG, Benth JŠ, MacGregor EA, Lundqvist C, Russell MB(2015) Menstrual versus non-menstrual attacks of migrainewithout aura in women with and without menstrual migraine.Cephalalgia 35: 1261-1268.19. Zaeem Z, Zhou L, Dilli E (2016) Headaches: a review of the roleof dietary factors. Curr Neurol Neurosci Rep 16: 101.7.Rajeh SA, Awada A, Bademosi O, Ogunniyi A (1997) Theprevalence of migraine and tension headache in Saudi Arabia: acommunity based study. Eur J Neurol 4: 502-506.20. Panconesi A (2016) Alcohol-induced headaches: Evidence for a8.Buse DC, Loder EW, Gorman JA, Stewart WF, Reed ML, et al.(2013) Sex Differences in the Prevalence, Symptoms, andAssociated Features of Migraine, Probable Migraine and OtherSevere H eadache: Results of the American Migraine Prevalenceand Prevention (AMPP) Study. Headache 53: 1278-1299.Photophobia and seasonal variation of migraine in a subarcticpopulation. Headache 57: 1206-1216.9.Natoli JL, Manack A, Dean B, Butler Q, Turkel CC, et al. (2009)Global prevalence of chronic migraine: A systematic review.Cephalalgia 30: 599-609.10. Stokes M, Becker WJ, Lipton RB, Sullivan SD, Wilcox TK, et al.(2011) Cost of health care among patients with chronic andepisodic migraine in Canada and the USA: Results from theInternational Burden of Migraine Study (IBMS). Headache 51:1058-1077.11. Munakata J, Hazard E, Serrano D, Klingman D, Rupnow MF, et al.(2009) Economic burden of transformed migraine: results fromthe American Migraine Prevalence and Prevention (AMPP)Study. Headache 49: 498-508.12. Katsarava Z, Buse DC, Manack AN, Lipton RB (2012) Defining thedifferences between episodic migraine and chronic migraine.Curr Pain Headache Re
alpha. The questionnaire was translated in Arabic language to facilitate the Non-English-speaking participants and then back to back translated. The questionnaires were distributed manually among the participants according to the criteria of International Journal of Neurology and Neuroscience ISSN 2171-6625 Vol.11 No.1:313 2020
TM 11-6625-2781-14-6 TECHNICAL MANUAL NO. 11–6625-2781-14-6 . REPORTING OF ERRORS You can improve this manual by recommending improvements using DA Form 2028-2 located in the back of the manual. Simply tear out the self-addressed form, fill it out as shown on the sample, fold . Fill out and forward
TM 9-6625-1753-14 C3 TECHNICAL MANUAL HEADQUARTERS DEPARTMENT OF THE ARMY No. 9-6625-1753-14 WASHINGTON, D. C., 4 April 1968 Operator, Organizational, DS, And GS
NAME OF CA 90822, United StatesJOURNAL World Journal of Gastroenterology ISSN ISSN 1007-9327 (print) ISSN 2219-2840 (online) LAUNCH DATE October 1, 1995 FREQUENCY Weekly EDITORS-IN-CHIEF Damian Garcia-Olmo, MD, PhD, Doctor, Profes-sor, Surgeon, Department of Surgery, Universidad Autonoma de Madrid; Department of General Sur-
Columbus, GA 31909-3739 706-323-6403 Mhorn6122@knology.net Officers President and Asst. Treasurer Edwin K. Adam P.O. Box 2171 Clarksville, IN 47131-2171 812-945-1166 Vice President and Membership John T. Burke 5704 Hastings Square Columbus, GA 31909-4737 706-563-8909 Secreta
Test Se Electron TM 11-6625-274-12 Tube tester Tube TV-7D/U Test Set, Electron TM 11-6625-316-12 Tube tester Tube TV-2/U (Depot only) Capacitance TM 11-2646A Test set Inductance Resistance Test Set AN/URM-90 Crystal Rectifier Test TM 11-1242 Crystal test set Set TS-268E/U Meter Test Set TM 1
E-Mail: iinfo@lisega.fr Internet: wwww.lisega.fr LISEGA IInc. USA 375, LLisega BBoulevard Newport, TTennessee 337821 Tel.: ((0) 4423 6625-2000 Fax: ((0) 4423 6625-9009 E-Mail: iinfo@lisega.com Internet: wwww.lisega.com LISEGA LLtd. Great BBritain Midsummer HHouse 415 aa, MMidsummer BBoulevard Buckinghamshire, MMK9 33BN Central MMilton KKeynes
ISSN: 2167-4256 2. Curtis's Botanical Magazine [1995- ] (Plants . Journal of Canadian Art History ISSN: 0315-4297 17. Journal of Correctional Education . Moving Wall: N/A Publisher: Correctional Education Association ISSN: 0022-0159 Note: Journal of Correctional Education (1949-1972) is a previous title to Journal of Correctional .
Advanced Engineering Mathematics 6. Laplace transforms 21 Ex.8. Advanced Engineering Mathematics 6. Laplace transforms 22 Shifted data problem an initial value problem with initial conditions refer to some later constant instead of t 0. For example, y” ay‘ by r(t), y(t1) k1, y‘(t1) k2. Ex.9. step 1.
