Headache syndromes in the eastern province of Saudi Arabia

The pattern of headache syndromes in 222 subjects (142 Saudi nationals, 80 non-Saudis) seen at Al-Khobar, Saudi Arabia is presented. Headaches were common, and accounted for 13% of all neurological outpatients. They affected mainly young adults, with a peak frequency in the third decade for Saudis and the fourth for non-Saudis. They were rare in those under 10 and above 50 years old. Among Saudis, females outnumbered non-Saudi males were more frequent than females in all age groups except the second decade. The main types were tension headache (66%) and migraine (22%). Acute/chronic sinusitis was an uncommon cause of headache. Tension headache affected mainly individuals between 21 and 40 years of age (69%). It showed a female preponderance in Saudis aged 11-20 and above 40 years, unlike the male predilection in non-Saudis. Migraine showed a definite female predilection only in Saudis in the fourth decade (female to male ratio of 4:1). A positive family history for headache was present in 10% of the cases. The major precipitating factor for headaches was stress related to family or working conditions. Other triggers included hunger and prolonged exposure to excessive heat or sunlight. The pattern of headaches in Saudi nationals may be related to the prevalent sociocultural factors, and the differences observed between them and non-Saudis probably reflect the demographic status of non-Saudis in the Kingdom as a consequence of governmental recruitment policy.