The prevalence of primary headache disorders in Ethiopia

Abstract

BackgroundKnowledge of the epidemiology of primary headache disorders in sub-Saharan Africa (SSA) remains very limited. We performed a population-based survey in rural and urban areas of Ethiopia, using methods similar to those of an earlier study in Zambia and tested in multiple other countries by Lifting The Burden.MethodsIn a cross-sectional survey we visited households unannounced in four regions of Ethiopia: the mostly urban populations in Addis Ababa and its environs and rural populations of selected districts in Oromia, Amhara and South Nations Nationalities and People’s Regions States (SNNPRS). We used cluster-randomized sampling: within clusters we randomly selected households, and one adult member (18–65 years old) of each household. The HARDSHIP structured questionnaire, translated into the local languages, was administered face-to-face by trained interviewers. Demographic enquiry was followed by diagnostic questions based on ICHD-II criteria.ResultsFrom 2,528 households approached, 2,385 of 2,391 eligible members (1,064 [44.7%] male, 596 [25.0%] urban) consented to interview (participating proportion 99.8%). Headache in the preceding year was reported by 1,071 participants (44.9% [95% CI: 42.4–46.3]; males 37.7%, females 49.9%), and headache yesterday by 170 (7.1% [6.2–8.2]; males 45 [4.1%], females 125 [9.2%]). Adjusted for gender, age and habitation (urban/rural), 1-year prevalence of migraine was 17.7%, of tension-type headache (TTH) 20.6%, of all headache on ≥15 days/month 3.2%, and of probable medication-overuse headache (pMOH) 0.7%. The adjusted prevalence of headache yesterday was 6.4%. Very few cases (1.6%) were unclassifiable. All headache disorders were more common in females. TTH was less common in urban areas (OR: 0.3; p < 0.0001), but pMOH was very strongly associated (OR: 6.1; p < 0.0001) with urban dwelling. Education was negatively associated with migraine (OR: 0.5–0.7; p < 0.05) but (at university level) positively with pMOH (OR: 2.9; p = 0.067). Income above ETB 500/month showed similar associations: negatively with migraine (OR: 0.8; p = 0.035), positively with pMOH (OR: 2.1; p = 0.164).ConclusionsFindings for migraine and TTH in Ethiopia were quite similar to those from Zambia, another SSA country; pMOH was much less prevalent but, as in Zambia, essentially an urban problem. Primary headache disorders are at least as prevalent in SSA as in high-income western countries.

The burden of headache disorders in Ethiopia: national estimates from a population-based door-to-door survey

“…This enquiry obviates the potential problem of faulty recall over periods of 3 months [14]. In fact, the predicted 1-day prevalence of headache based on reported frequency over the preceding 3 months was 6.9% - very close to the 7.1% reported prevalence of HY [13]. As for the effect of HY on activities yesterday, the lost “output” per person in the entire population of 3.0% was entirely compatible with the averaged lost paid workdays of 1.6%, given that the former included all planned activities (additionally household work, which had similar losses to paid work, and social events).…”

“…People with pMOH in Zambia were 8.3% disabled and lost 7.4% of paid workdays and 5.0% of household workdays [10]. These estimates are different from those in Ethiopia (13.4%, 29.2% and 16.0%), but, with such different prevalences (7.1% [30] versus 0.7% [13]), and numbers in Ethiopia very small, nothing should be made of this. In other words, with similar prevalences of all but pMOH, the modest differences in headache-attributed burden can be explained by geographical, cultural and environmental differences between these two countries.…”

“…Furthermore, the essential messages here for policy purposes relate to headache overall rather than to any headache type, and they are not significantly affected by this limitation. The study had several strengths, also noted previously [13]. We employed population-based sampling, included diverse regions with a large sample of >2400, applied ICHD-II diagnostic criteria [26] and used established methodology also tested in numerous other countries [14].…”

The prevalence of primary headache disorders in Saudi Arabia: a cross-sectional population-based study

“…The same review showed large geographical gaps in our knowledge [1]. Lifting The Burden (LTB), conducting the Global Campaign against Headache [9][10][11][12], has since been supporting a series of population-based studies to fill these gaps [13][14][15][16][17][18][19][20]. Since there were, in 2007, no data on headache from the whole of the Eastern Mediterranean Region (EMR) [1], these studies have included Pakistan [20], an EMR country with the sixth largest population in the world.…”

Prevalence and Profile of Migraine Patients in Brazzaville, Congo

“…In Ethiopia, a study conducted in conditions similar to that of Zambia, found a prevalence of migraine of 19.0% in the entire population (rural and urban). However, the diagnosis of migraine was determined by an algorithm based on ICHD-2 criteria [17]. In these two studies, apart from the problem relating to the criteria for selecting subjects, there is also a problem of validation of the diagnosis of migraine.…”