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Focus on general migraine burden and during pregnancy in Arab countries
During a regional symposium of the Pan-Arab Union of Neurological Societies (PAUNS) held at #WCN2021, experts discussed the burden of migraine in Arab countries. Migraine is highly prevalent worldwide, but it is still under-estimated, under-recognized, under-diagnosed and under-treated. The prevalence of migraine is higher than average in some Arab countries with associated heightened burden. Migraine weighs heavy on women of reproductive age with many fears concerning migraine during pregnancy.
Burden of migraine in Arab countries
More than 10% of the global population is estimated to suffer from migraine,1 while population-based studies estimate the prevalence of migraine in Middle Eastern countries ranging from 7‒9% in Qatar1 and Jordan,2,3 to 17% in Egypt,4 and as high as 23‒25% in Kuwait and Saudi Arabia.5,6 The variance in migraine prevalence may be explained by genetic or environmental differences postulated Professor Maged Abdel Naseer of the Cairo University, Egypt.
Migraine prevalence ranges from 7% to 25% in Arab countries
Further examination of the population of upper Egypt identifies a lifetime prevalence of migraine of 3.38/100 while the highest prevalence is found during early adult life (18–40 years) with a prevalence of 4.77/100.7 Most attacks recorded by people with migraine were of moderate to severe intensity (97%) and two-thirds of migraine patients reported that the headache significantly interfered with their daily activities.7
Beyond the headache, migraine affects an individual’s quality of life and functional ability both during, immediately after, and between migraine episodes. Globally, headache disorders (migraine, tension-type headache, and medication overuse headache) occupy sixth place among the leading causes of disability; however, the burden is higher in North Africa and the Middle East where headache disorders rank as the third leading cause of disability.8
Migraine affects an individual’s quality of life and functional ability both during, immediately after, and between migraine episodes
Self-medicating for headaches is highly common in the Middle East, and chronic and inappropriate use of over-the-counter analgesic drugs can lead to medication overuse headache.3 A community-based study in Kuwait found a prevalence of episodic migraine of 23%, chronic migraine among 5%, and medication overuse headache in 2% of the population. Higher frequency and severity of the headaches were associated with increasing social and work-related burden.5
Self-medicating for headaches is highly common in the Middle East, and inappropriate use of analgesic drugs can lead to medication overuse headache
Migraine impact on pregnancy
The peak prevalence of migraine occurs in women of reproductive age. Around 20% of women with migraine fear to get pregnant because they believe that migraine will worsen during pregnancy, make their pregnancy difficult, and that migraine medications may have negative effects on their unborn child.9 However, studies show that migraine tends to improve with pregnancy for many women, especially during the second and third trimester.10
Migraine affects the pregnancy plans of many women
Dr Jasem Al-Hashel, Kuwait University, Kuwait, considered that for those women with continued migraine during pregnancy, non-pharmacological measures are preferred to manage migraine. When needed, a 2021 systematic review of the management of primary headaches (including migraine) during pregnancy concludes that, for prevention calcium channel blockers and antihistamines, and for treatment triptans, may not be associated with fetal/child adverse effects.11
Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.
References
- Atif M, et al. J Pharm Pract Community Med 2017;3(1):3‒11.
- ALBashtawy M, et al. J Sch Nurs 2019;35:88‒95.
- Alzoubi KH, et al. J Headache Pain 2009;10:265‒70.
- El-Sherbiny N, et al. J Headache Pain 2015;16:85.
- Al-Hashel JY, et al. Neuroepidemiology 2017;48:138‒46.
- Muayqil T, et al. Eur Neurol 2018;79:126‒34.
- El-Tallawy H, et al. Egyptian J Neurology, Psychiatry & Neurology 2019;55:20.
- Steiner TJ, et al. 2016 J Headache Pain 2016;17:104.
- Ishii R, et al. Mayo Clin Proc 2020;95:2079‒89.
- Melhado EM, et al. Can J Neurol Sci 2007;34:187‒92.
- Saldanha IJ, et al. Headache 2021;61:11‒43.
