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.

Keywords: Geographic regions; Headache frequency; ICHD-3; MOH; Migraine; Neurology clinics; Pain perception; The Head-MENAA study.

Fig. 1

Prevalences of headaches in the participating Neurology Clinics in the Middle East, Asia, and Africa (at the bottom left corner)

Fig. 2

Distribution of mean severity of headache according to countries (*different than Türkiye, Turkish Republic of Northern Cyprus, Iran, Egypt, Senegal, Tatarstan, and Azerbaijan, p < 0.001)

Fig. 3

The general distribution of headache types

Fig. 4

Distribution of headache types according to regions (1; Migraine, 2; TTH, 3; TACs, 4; Other primary headache disorders, 5; Headache attributed to trauma or injury to the head and/or neck, 6; Headache attributed to cranial or cervical vascular disorder, 7; Headache attributed to non-vascular intracranial disorder, 8; Headache attributed to a substance or its withdrawal, 9; Headache attributed to infection, 10; Headache attributed to disorder of homeostasis, 11; Headache or facial pain attributed to disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure, 12; Headache attributed to psychiatric disorder, 13; Painful lesions of the cranial nerves and other facial pain)