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Original Research 


Ghada Kamal Gouhar et al, 2018;2(3):103–108.

International Journal of Medicine in Developing Countries

Migraine among Princess Nourah Bint Abdulrahman University students in Riyadh, Saudi Arabia

Ghada Kamal Gouhar1*, Rajaa Eltoum Tamimm2, Sarah Musallam AlMahri3, Aroob Laheg Almogati3, Hajar Mohammad Alsaeed3, Modhi Saleh Almuryidi3, Rawan Ahmed Skair3, Abdullah Awadh Almalki4

Correspondence to: Ghada Kamal Gouhar

*Professor, Medical Radiology and Body Imaging, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.

Email: ghadagouhar@yahoo.com

Full list of author information is available at the end of the article.

Received: 14 May 2018 | Accepted: 26 June 2018


ABSTRACT

Background:

Migraine is a unilateral headache which is accompanied by sensory symptoms. Migraine affects more than 10% of the general population being more common in females than males. It affects the performance of those who suffer from it. There are several factors that trigger a migraine, including stress, sleep, and certain dietary substances.


Methodology:

This is a cross-sectional, questionnaire-based study of 523 female students. Participants who had two or more headaches in the last 3 months formed the headache group. Then two preliminary questions were asked to the headache group and participants with at least one affirmative response were asked to perform the validated ID-Migraine test.


Results:

Two hundred and thirty-four out of 523 participants had suffered a migraine. The mean age of all participants was 20.97 ± 1.64 years, while the mean age of migraine patients was 20.93 ± 1.57 years. The prevalence of migraine was 44.74%. Lack of sleep was a triggering factor for migraine represented by 89.3%, followed by stress which represented 74.8%; the least common factor was excessive drinking of coffee (20.5%). Moderate pain was the most common degree among participants.


Conclusion:

The prevalence of migraine was moderate and represented 44.74% of female students in Princess Nourah Bint Abdulrahman University, the lack of sleep and stress were the most common factors that triggered it.


Keywords:

Migraine prevalence, migraine in females, MIDAS, migraine in KSA.

Introduction

Migraine is one of the most prevalent neurological disorders. The public health burden of migraine is substantial due to its high prevalence and prominent temporary disability [1]. It is a disabling painful condition that is prevalent three times amongst women against men, especially young and middle-aged women [2]. Migraine is highly prevalent among university students and it is associated with impaired academic performance and limited daily activities. It has negative effects among university students, who indeed require constant concentration and a high level of performance [3]. To this day, migraine has become considerable and interesting among university students due to its negative effects on their concentration, performance, and quality of life [2]. The prevalence of migraine among medical students ranges from 11% to 40% worldwide [4]. Migraine affects more than 10% of the general population [57], and it ranks as the seventh disabling disease worldwide [8].

It is more common in females, especially young and those of middle age [9,10]. In Turkish study [11], the prevalence in males was reported to be 10.9% while in females it was 21.8%. There are several internal and external stimuli which provoke a migraine headache [3], it was reported that hormonal changes, especially the levels of estrogen, can stimulate migraine, also genetic effect was reported as migraine stimulus [12,13]. Researchers demonstrated that sleeplessness, stress, menstrual cycle, eating habits, oral contraceptives, frequent traveling, physical activities, food items, changes in weather conditions, and temperature are the factors that trigger migraine headaches [14].

Migraine has a negative effect on concentration, quality of life, and performance of students [15,16], it is also associated with morbidities and disability of students [17]. Migraine was more prevalent in university students, it resulted in a limitation of activities of the students and impairing their academic performance [18]. Prevalence of migraine between university students differs between countries, studies from Oman and Qatar showed that prevalence was 12.2% and 7.9%, respectively [19,20]. A study on female students in Taibah University, Kingdom of Saudi Arabi showed that the migraine prevalence was 61.8% [3].

The difference in prevalence in different studies was attributed to the method used to diagnose migraine-type headaches [21]. Post-traumatic stress disorders, depression, and anxiety are common comorbid conditions in migraineurs [2224], so if migraine is left untreated, these conditions might cause an episodic migraine to develop into a chronic migraine [8]. Reduced quality of life, increased migraine-related disability, and the negative impact of treatment outcomes can result from an untreated migraine [8]. There are several available questionnaires to quantify different aspects of migraine [25]; migraine disability assessment scale (MIDAS) is one of them which assess the disability related to migraine in a period of 3-months [26]. In migraine patients, assessing the disability is very important for both the physician and patients to determine the severity of the disease; hence, suitable treatment can be determined [27]. The present study was aimed to estimate the prevalence, severity, identify the common triggers, and the effect of migraine on students of Prince Nourah Bint Abdulrahman University (PNU).

Subjects and Methods

This was a cross-sectional questionnaire-based study which was performed on Princess Nourah Bint Abdulrahman University students in the academic year 2016–2017. The study included 539 female students, 16 of them were excluded as they didn’t complete the questionnaire. Finally, 523 completed questionnaires were obtained. The study was conducted after getting approval from the Institutional Review Board of PNU. The data were collected from students by using a validated questionnaire which was taken from a published study [21].

Descriptive statistics were represented as percents, while continuous variables were expressed as a mean ± standard deviation. Analysis of quantitative data by t-test and association of qualitative variables by chi-square test was conducted. A p-value less than 0.05 was considered as statistically significant. Statistical analysis was conducted by SPSS software version 16.

Results

The present study included 523 female students, 234 of them had a migraine (44.74%). The mean age of all participants was 20.97 ± 1.64 years, while the mean age of migraine patients was 20.93 ± 1.57 year. The large majority of participants were in level 1–4 followed by those in level 5–8 and finally, students were in level 9–12. The large majority of students were singles and living with family. Most of the patients with migraine 143 (61.1%) had no family history of migraine, while 91 (38.9%) had a family history of migraine. The demographics of all participants and migraine patients were shown in Table 1.

The factors that trigger migraine were investigated, the most common factor was lack of sleep which represented 89.3% (209), followed by stress representing 74.8% (175), then menstruation representing 46.6% (109), while excessive sleep and special food represented 35.9% (84) and 25.2% (59), respectively and finally, excessive drinking of coffee 20.5% (48) (Fig. 1).

According to the students, ice cream was the type of food that mostly triggered migraine attack (9.8%), then fatty food (9.4%), other types of food represented lower percentages (Table 2).

The level of migraine pain was divided into four categories; no pain, mild pain, moderate pain, and severe pain. There was only one student (0.8%) who had little or no pain, 39 students had mild pain; most of them (20 students) were from other (non-health) colleges. There were 141 students who had moderate pain, most of them were participants from other (non-health) colleges (80), and severe pain was experienced by 51 students (Fig. 2).

Table 1. Demographics of all participants and migraine patients.

All participants (N = 523) N (%) Migraine patients (N = 234) N (%) Social demographics
20.97 ± 1.64 20.93 ± 1.57 Age (years): (Mean ± SD)
82 (15.7%)
135 (25.8%)
306 (58.5%)
39 (16.7%)
67 (28.6%)
128 (54.75%)
College
Medical college
Health colleges
Other (non-health) colleges
279 (53.8%)
212 (40.8%)
28 (5.4%)
124 (53.7%)
99 (42.9%)
8 (3.5%)
Level
1–4
5–8
9–12
30 (5.7%)
488 (93.5%)
4 (8%)
18 (7.7%)
214 (99.1%)
2 (100%)
Marital state
Married
Single
Other
467 (89.8%)
14 (4.6%)
29 (5.6%)
204 (87.6%)
15 (6.4%)
14 (6%)
Residence
With family
Student housing
Other

Figure 1. Factors trigger a migraine represented by the frequency.

Figure 2. Level of pain among participants.

Table 2. Opinion of students about food that triggers migraine.

N (%) Special food type
8 (3.4%) Cheese
13 (5.6%) Chocolate
6 (2.6%) Citrus fruits
22 (9.4%) Fatty foods
23 (9.8%) Ice cream
6 (2.6%) Hotdogs and other cured meats
5 (2.1%) Monosodium glutamate, as Chinese food
10 (4.3%) Aspartame and artificial sweeteners

MIDAS estimates the disability related to migraine in a period of 3-months, the scale of Midas was categorized into four groups; little/no disability, mild, moderate, and severe disability. The majority of participants (156) had little or no disability, distributed as 30, 54, and 72 students of medicine, health, and other (non-health) colleges, respectively. There were 68 students who had a mild disability, most of them (46) were from other (non-health) colleges followed by those from health (13) and medical (9) colleges. Students from other (non-health) colleges were the only students who had a moderate and severe disability, where nine students had moderate, and only one student had a severe disability. Participants in level 3–6 and level 7–12 experienced pain with no significant difference (p-value = 0.3), while there was a significant difference between the two groups regarding the degree of disability (p-value = 0.003), where more participants from level 7–12 had a little and mild disability (Table 3).

Table 3. Correlation between severity of pain and MIDAS degrees with participants’ levels.

Variables Level 3–6 (N = 8) Level 7–12 (N = 27) p-value
Severity of pain
Little/No 0 0 0.3
Mild 2 (50%) 2 (50%)
Moderate 4 (20%) 16 (80%)
Severe 2 (18.2%) 9 (81.8%)
MIDAS
Little/No 5 (18.5%) 22 (81.5%) 0.003
Mild 3 (37.5%) 5 (62.5%)
Moderate 0 0
Severe 0 0

Discussion

This is the first registered study that estimated the prevalence of migraine among female students in different colleges of PNU, Riyadh in Saudi Arabia. There were few studies focusing on migraine among university students in Arab Gulf Countries showing noticeable differences in prevalence [1].

The present study included 523 female students, the mean age of patients with migraine was 20.93 years. The prevalence of migraine between female students was found to be 44.74% with higher prevalence in other (non-health) colleges (55% of the migraine group). Higher prevalence 61.8% of migraine was reported by Saudi study [3] on female students from Taibah University. A study on medical students at King Abdulaziz University in Jeddah showed that migraine prevalence was 26.3% [17].

A study from Qatar and Oman [19,20] showed that the prevalence of migraine among medical students was 9.7% and 12.2%, respectively. Also, the low prevalence of migraine (7.2%) was reported in Turkey study on university students [21].

In the present study, migraine was more prevalent (53.7%) in students from level 1–4 than those from level 5–8 (42.9%), and it was less common in those from level 9–12 (3.5%). In a study from Kuwait [28], there was a higher prevalence in medical students from the last grade and first grade.

The present study showed that most of the patients with migraine (61.1%) didn’t have the family history of migraine. However, an association between a family history of migraine and migraine was reported in a previous Saudi study [17].

The present study revealed that lack of sleep was the factor that triggered migraine the most, lack of sleep represented 89.3% to stimulate migraine, while stress was the second reason representing 74.8% and menstruation was at the third rank (46.6%) to trigger a migraine. Excessive sleeping, special food, and excessive drinking of coffee were the least factors that stimulated a migraine (35.9%, 25.2%, and 20.5%, respectively). In a Saudi study [3], it was found that the most triggering factors for a migraine were light, loudness, changes in weather and certain smells, while stress represented 56.1%. Other studies revealed that stress represented 83.5% and 84% as a triggering factor. Another study [17] demonstrated that stress and sleep disturbance were the most common triggers of migraine.

A study on medical students from Kuwait University [28] revealed that irregular sleep, reading hours, anxiety, exams, smoking, and fasting were the most common trigger of migraines. In the current study, it was found that special food had the role in triggering migraine and represented 25.5%. Ice Cream was the most common type to trigger migraine (9.8%) followed by fatty food (9.4%), chocolate (5.6%) then aspartame and artificial sweeteners (4.3%). Cheese, citrus fruits, cured meat, and Chinese food represented the least type of food (3.4%, 2.6%, 2.6%, and 2.1%, respectively) that stimulated migraine.

Regarding the degree of pain, the three degrees of pain; mild, moderate, and severe were more prevalent in female students from other (non-health) colleges followed by those from Health College, the three degrees of pain were less prevalent in female students from medical college.

A Saudi study [3] demonstrated that migraine prevalence was higher in students from theoretical colleges than in those from practical colleges.

In the present study, we found no significant difference between students’ levels and severity of pain (p-value = 0.3). A migraine is important to be assessed in university students because of its disability potential [10]. The current study showed that disability degrees differed between different levels of students and there was a significant difference (p-value = 0.003), where more students from level 7–12 experienced mild disability than those in level 3–6, while fewer students in level 3–6 had no disability than those in level 7–12, however, this significance can be attributed to a large number of students in level 7–12 than those in level 3–6. In medical students, the median pain level was moderate and Migraine Disability Assessment Score was small.

Conclusion

The prevalence of migraine was 44.74% in PNU; this percent was moderate compared to previous studies which showed higher and much lower prevalence. This reflects diversity in the migraine prevalence between different studies even in the same country. Migraine with different degrees was more common in female students from other colleges than other participants. Migraine was more prevalent in students with the first level than those in last levels. There was a significant difference in experiencing disability between students at different levels. The most common factors that triggered migraine were lack of sleep, stress, and menstruation.

Acknowledgment

None.


List of abbreviations

MIDAS Migraine disability assessment scale
PNU Princess Nourah Bint Abdulrahman University

Consent for publication

Informed consent was obtained from the participants.


Ethical approval

Yes.


Funding

None.


Declaration of conflicting interests

None.


Author details

Ghada Kamal Gouhar1, Rajaa Eltoum Tamimm2, Sarah Musallam AlMahri3, Aroob Laheg Almogati3, Hajar Mohammad Alsaeed3, Modhi Saleh Almuryidi3, Rawan Ahmed Skair3, Abdullah Awadh Almalki4

  1. Radiology Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
  2. Department of Internal Medicine, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
  3. Medical Student (4th year), College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
  4. HSRC, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia

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How to Cite this Article
Pubmed Style

Gouhar GK, Tamimm RE, Almahri SM, Almogati AL, Alsaeed HM, Almuryidi MS, Skair RA, Almalki AA. Migraine among Princess Nourah Bint Abdulrahman University students in Riyadh, Saudi Arabia. IJMDC. 2018; 2(3): 103-108. doi:10.24911/IJMDC.51-1522164334


Web Style

Gouhar GK, Tamimm RE, Almahri SM, Almogati AL, Alsaeed HM, Almuryidi MS, Skair RA, Almalki AA. Migraine among Princess Nourah Bint Abdulrahman University students in Riyadh, Saudi Arabia. http://www.ijmdc.com/?mno=295014 [Access: November 21, 2018]. doi:10.24911/IJMDC.51-1522164334


AMA (American Medical Association) Style

Gouhar GK, Tamimm RE, Almahri SM, Almogati AL, Alsaeed HM, Almuryidi MS, Skair RA, Almalki AA. Migraine among Princess Nourah Bint Abdulrahman University students in Riyadh, Saudi Arabia. IJMDC. 2018; 2(3): 103-108. doi:10.24911/IJMDC.51-1522164334



Vancouver/ICMJE Style

Gouhar GK, Tamimm RE, Almahri SM, Almogati AL, Alsaeed HM, Almuryidi MS, Skair RA, Almalki AA. Migraine among Princess Nourah Bint Abdulrahman University students in Riyadh, Saudi Arabia. IJMDC. (2018), [cited November 21, 2018]; 2(3): 103-108. doi:10.24911/IJMDC.51-1522164334



Harvard Style

Gouhar, G. K., Tamimm, . R. E., Almahri, . S. M., Almogati, . A. L., Alsaeed, . H. M., Almuryidi, . M. S., Skair, . R. A. & Almalki, . A. A. (2018) Migraine among Princess Nourah Bint Abdulrahman University students in Riyadh, Saudi Arabia. IJMDC, 2 (3), 103-108. doi:10.24911/IJMDC.51-1522164334



Turabian Style

Gouhar, Ghada Kamal, Rajaa Eltoum Tamimm, Sarah Musallam Almahri, Aroob Laheg Almogati, Hajar Mohammad Alsaeed, Modhi Saleh Almuryidi, Rawan Ahmed Skair, and Abdullah Awadh Almalki. 2018. Migraine among Princess Nourah Bint Abdulrahman University students in Riyadh, Saudi Arabia. International Journal of Medicine in Developing Countries, 2 (3), 103-108. doi:10.24911/IJMDC.51-1522164334



Chicago Style

Gouhar, Ghada Kamal, Rajaa Eltoum Tamimm, Sarah Musallam Almahri, Aroob Laheg Almogati, Hajar Mohammad Alsaeed, Modhi Saleh Almuryidi, Rawan Ahmed Skair, and Abdullah Awadh Almalki. "Migraine among Princess Nourah Bint Abdulrahman University students in Riyadh, Saudi Arabia." International Journal of Medicine in Developing Countries 2 (2018), 103-108. doi:10.24911/IJMDC.51-1522164334



MLA (The Modern Language Association) Style

Gouhar, Ghada Kamal, Rajaa Eltoum Tamimm, Sarah Musallam Almahri, Aroob Laheg Almogati, Hajar Mohammad Alsaeed, Modhi Saleh Almuryidi, Rawan Ahmed Skair, and Abdullah Awadh Almalki. "Migraine among Princess Nourah Bint Abdulrahman University students in Riyadh, Saudi Arabia." International Journal of Medicine in Developing Countries 2.3 (2018), 103-108. Print. doi:10.24911/IJMDC.51-1522164334



APA (American Psychological Association) Style

Gouhar, G. K., Tamimm, . R. E., Almahri, . S. M., Almogati, . A. L., Alsaeed, . H. M., Almuryidi, . M. S., Skair, . R. A. & Almalki, . A. A. (2018) Migraine among Princess Nourah Bint Abdulrahman University students in Riyadh, Saudi Arabia. International Journal of Medicine in Developing Countries, 2 (3), 103-108. doi:10.24911/IJMDC.51-1522164334