Burden of hidden migraine among the Arab general population: a cross-sectional study

Migraine is a common type of primary headache which is responsible for one-third of the headache cases. It's also considered the third highest neurological disease with disability in 2021, however, underdiagnosis of migraine remains a significant health problem. This study aims to assess the prevalence of hidden migraine identified by screening among the Arab general population, describe the characteristics of headache attacks, and assess disability and distress associated with migraine.

This cross-sectional study was conducted between April and June 2024 among the general population of eight Arab countries using a self-administered online questionnaire to collect sociodemographic data and medical history. The questionnaire also included the ten-item Kessler Psychological Distress Scale (K10), Migraine Screen Questionnaire (MS-Q), and Migraine Disability Assessment Questionnaire (MIDAS).

A total of 2152 individuals completed the questionnaire with a median age of 24 (21-29). Among them 683 (31.7%) individuals were screened positive by MS-Q. Using regression analysis, the independent predictors for positive screening were being Saudi Arabian, having one or more diseases, and having severe psychological distress with adjusted odds ratios of 0.622, 0.282, and 1.329 respectively. Among positive cases, 667 (97.7%) reported having headaches in the past 3 months. Phonophobia (50.97%) and photophobia (49.33%) were the most common associated symptoms. Sleep disturbance (66.72%) and noise (63.87%) were the most common triggering factors while sleep (71.81%) and self-medication (68.52%) were the most common relieving factors. Only 25.34% reported having aura with the last attack. According to MIDAS scores, 459 (67.2%) positive cases had moderate or severe disabilities. Regression analysis identified being a housewife and having one or more diseases as the independent predictors of having moderate or severe disabilities with adjusted odds ratios of 0.228 and 0.523 respectively.

Migraine is still underdiagnosed in Arab countries which causes significant disability among positive cases. Raising awareness about the importance of early migraine diagnosis is crucial for encouraging the general population to seek medical advice once they have symptoms.