Secondary headache disorders in Turkey, the Middle East, Asia, and Africa: A cross-sectional, multicenter study

Abstract

Background This multicenter cross-sectional study aimed to determine the frequency and characteristics of secondary headaches in different geographic regions, including Turkey, the Middle East, Asia, and Africa. Methods Patients were admitted to the study on a particular day each week for five consecutive weeks between 1 April and 16 May 2022. Before the study, all researchers underwent a constructed briefing about the use and code of the ICHD-3 criteria. The study was conducted in two stages. In the first stage, data on secondary headaches were compared between the regions. In the second stage, the sub-diagnoses of secondary headaches were analyzed only in Turkey. Results A total of 4144 (30.0%) of the 13,794 patients reported headaches as the main symptoms at admission. A total of 422 patients were excluded from the study. In total, 1249 (33.4%) of 3722 patients were diagnosed as having secondary headaches (Turkey [n = 1039], Middle East [n = 80], Asia [n = 51], Africa [n = 79]). The frequency of secondary headaches (Turkey 33.6%, Africa 30.1%, Middle East 35.5%, Asia 35.4%) did not differ significantly between the regions (p > 0.05). The most common subtype of secondary headaches was headache attributed to substances or their withdrawal in all the studied regions. There was a female predominance in all regions, but it was lower in Africa than in Turkey. The severity and density of headaches differed significantly between the regions, with patients from Africa reporting milder pain than patients from other regions. In Turkey, the most common sub-diagnoses of secondary headaches were medication overuse headache, idiopathic intracranial hypertension, and cervicogenic headache. Conclusion In the present study, one in three patients with a headache had a secondary headache. Headache attributed to substances or their withdrawal was the most common subtype of secondary headaches in all the studied regions. The female predominance of secondary headaches was lower in Africa than in Turkey. The severity and density of headaches differed significantly between regions, with patients from Africa reporting milder pain.

Health equity, care access and quality in headache – part 1

“…The prevalence of secondary headache disorders was 1249/3722 (33%), with no remarkable differences within the studied regions. The most prevalent headache disorders were medication overuse headache (9%), idiopathic intracranial hypertension (3%), and cervicogenic headache (3%) [ 108 ].…”

The World Health Organization Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders and the headache revolution: from headache burden to a global action plan for headache disorders

“…Secondary headaches in particular constitute a matter of concern due to the limited availability of instruments for differential diagnosis. A recent cross-sectional investigation showed that approximately one-third of headaches were found to be secondary in African, Middle-East and Asian countries, the most common subtype of secondary headaches was headache attributed to substances or their withdrawal [60]. However, several primary causes exist that need to be ruled out with laboratory (e.g.…”

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“…This entity is well studied and is categorized into eight different subtypes in the International Classification of Headache Disorders (ICHD) [3]. Hyperthyroidism is not listed amongst the most common causes of secondary headache in a study that included multiple centers located in Asia, Africa, The Middle East, and Turkey [4]. On the other hand, hyperthyroidism disorders like Graves' disease are also another highly prevalent entity; with the prevalence of suspected cases in Jeddah, Saudi Arabia, where the case to be reported is from, being 1.2% [5].…”