Migraine headache in Sudan

Migraine is a main form of headache, it is also a chronic and complex neuroinflammatory disease; it is characterized by recurrent severe headaches, usually affecting one side of the head, and often accompanied by nausea and blurred vision. In susceptible individuals, irritants can trigger migraine attacks, which can be considered as triggers or accelerators.


INTRODUCTION
Migraine is an intense and chronically repeated headache that is generally located to one side of the head, but can occur as a generalized throbbing headache with extension down to the neck or even the body. Clinically, there are different forms but migraine without aura (previously common migraine) is the commonest form. Migraine headaches can affect many people and women are slightly more susceptible than men. It is the second most common cause of headache, affecting approximately 15% of women and 6% of men (Macdonald, 2008).
The underlying mechanisms of migraine headache are not fully understood. It is, however, believed to contain the nerves and blood vessels of the brain. Initial recommended medication is with simple pain medication such as ibuprofen and paracetamol (Acetaminophen) for the headache, medication for the nausea, and the avoidance of triggers.
Specific medications such as triptans or ergotamines may be used in the patients for whom simple pain medications are not functioning (Loder et al., 2013).
Therefore, in this study, we aimed to study precipitating factors, clinical presentation, and treatment of migraine headache in adult Sudanese patients.

METHODOLOGY
This study is a descriptive prospective hospital-based study conducted at the National center for Neurological Science, Khartoum, Sudan, in the period from January 2016 to December 2018. The diagnosis of migraine headache was made based on the criteria of the International Headache Society for Migraine Headache (ICDH-3). One-hundred and thirty patients (aged more than 16 years) were enrolled in this study.
Data was collected using questionnaire filled by the researcher and a physical examination check list.

Inclusion criteria
• Sudanese patients aged more than 16 years

DISCUSSION
This is a cross-sectional facility-based study aimed to describe the precipitating factors, clinical presentation, and treatment of migraine headache. The study covered 130 study participants most of them were females (80%), more than half 56.9% were within 26-35 years of age, and a considerable proportion of them were housewives. Similar studies found that the migraine is common among the similar age group. (Ehsan, 2010) In Kurdish study, they realized that 33% of the patients were aged between 30 and 39 years, while 40.5% of patients experienced their first attack aged between 20 and 29 years.
Concerning the clinical presentation, the majority of the study participants had headache without aura in 81.5%, and most of the aura was in visual type 87.5%, with photophobia 51.5%, nausea 50%, and phonophobia in 45.4%. Other studies found (Stam et al., 2009)  This study had some limitations. The relatively limited number of study participants (130 only) may negatively affect the probability of founding significant relationships between different factors and relevant circumstances and characteristics with the overall incidence of migraine among the risky patients.
Another limitation is follow-up. Some outcomes may need to be followed over time for longer period. So, a long-term cohort follow-up design may be useful for more detailed description of the outcome.

CONCLUSION
This study concludes that females are predominately affected by migraine headache than males; the most affected age group ranged between 26 and 35 years. The most common presenting symptom was photophobia, and migraine headache was mainly presented without aura. Environmental conditions were the most frequent predisposing factor of headache in our study group. Moreover, the majority of patients received Acetaminophen as treatment and beta blockers as prophylaxis.