The Burden of Migraine among the Geriatric Population in Taif City, Saudi Arabia

Abdulrahim Ali Alghamdi^1* and Adel Obaidallah Aloufi²

^*Correspondence: Abdulrahim Ali Alghamdi, Senior Registrar of Family Medicine, Ministry of Health, KSA, Email:

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Introduction

If left untreated, a migraine headache can continue for up to 72 hours. This form of headache affects just one side of the head (unilaterally), causes moderate to severe pain, and may be made worse by physical exertion. Migraine headaches are often accompanied by nausea, vomiting, and light sensitivity. Before or during a migraine headache episode, some women may suffer an aura (for example, visual loss) [1]. “Migraine,” “headache,” and “sick headache” are all terminology used to characterize a migraine headache. The words “migraine” and “headache” are used to describe migraine headaches throughout this dissertation.

Migraine headache is a chronic condition with several comorbidities. The social expenses are raised as a result of the headaches and comorbidities. According to research, nurses with migraine headaches have a reduced quality of life as a result of their headaches [2]. Patients with migraines visit the emergency room more frequently than non-migraine patients, and they spend more money on medical care [3]. Other disorders that coexist with migraine headaches have been discovered by researchers. Depression is one such condition that frequently occurs alongside migraine and can be exacerbated when healthcare providers fail to recognize migraine headaches [4,5]. Because migraine headache is a serious disease with potential comorbidities for those who suffer from it, and because migraine headache is linked to higher societal expenses, nurses must have a better understanding of the whole experience of these patients.

Migraine commonly begins in infancy and peaks during puberty (about 12 years for boys and 15 years for girls [6], although it can begin at any age [7], a tiny fraction of patients in their sixth, seventh, and eighth decades of life report symptoms [8]. According to research [9,10], migraine is most active in the third and fourth decades of life, with the majority of older chronic migraine patients reporting a migraine onset before the age of 50 [11-13]. Importantly, given the global increase in life expectancy, migraine in the elderly is expected to become a much greater personal and public health problem in the next 40 years, since management is likely to be muddled by other health concerns and their related polypharmacy.

Study Aim

The goal of this study is to determine the prevalence of migraine headaches among the elderly in Taif, Saudi Arabia.

Methodology

Study design

This study is an analytical cross-sectional study.

Study setting

The study was conducted in Primary Healthcare setting in Taif city, Saudi Arabia.

Study population

The study included Saudi subjects aged 65 years or more visiting several PHCs and agreed to participate in the study after receiving orientation and an explanation about the objectives of the study.

Sample size

The minimum sample size for this study was decided according to the formula:

n=Z² X P X Q/D²

Where n: calculated sample size, Z: The z-value for the selected level of confidence=1.96, P: The assumed proportion of the elderly population with migraine=50%=0.5, Q: (1–P)=0.5, and D: The maximum acceptable error [precision level]=0.05. The estimated sample size was at least 65 individuals.

Data collection tools

Data was collected using a questionnaire that constituted sociodemographic factors, the Arabic translated Migraine Screen Questionnaire (MSQ) [14], and the Migraine-Specific QOL questionnaire (eprovideTM, 2018), which consists of 14 items, which was used to assess the quality of life associated with migraine.

Data collection method

The data collection form was distributed among eligible participants and their family companions to be filled in with assistance by the authors whenever needed.

Data management plan

The collected data were entered into a Microsoft Excel sheet and transferred to the Statistical Package for Social Sciences (SPSS) version 26 for further analysis. Descriptive analysis was performed using frequencies, percentages, means and standard deviations. Inferential statistics were done using the Kruskal-Wallis test and Mann-Whitney test, as the quality of life scores were not normally distributed. P-values that are equal to or less than 0.05 were regarded as statistically significant.

Ethical considerations

The questionnaire began with a short description of its purpose and goal, as well as a reminder that participation was entirely optional. Because this was observational research involving human beings, individuals who said “yes” to participating gave their informed consent. Names, dates of birth, and residences were not collected in the questionnaires. All of the responses were kept confidential and secure.

Results

The data collection form received 84 responses, of which 75 were complete. Males constituted 62.7% of participants. Age ranged from 65 to 71 years, whereas participants aged 65 to 69 constituted 56%. Only 12% resided in a rural area, and the majority (88%) resided in an urban area. Less than half (42.7%) of participants held a bachelor's degree or higher, and 81.3% were not working. Nearly half of the participants (48%) reported having current chronic diseases (Table 1).

Table 1: Sociodemographic characters of participants (n=75).

We used the Arabic translation of the Migraine Screen Questionnaire by which 30.7% of participants were diagnosed with migraine (Table 2).

Table 2: Migraine screen questionnaire items and diagnosis among participants (n=75).

MS-QoL results among participants with migraine are shown in Table 3. There was a significant association between MS-QoL and age (p=0.005), marital status (p=0.248), educational level (p=0.000), work status (p=0.000), and presence of chronic diseases (p=0.000). In our study, all subjects diagnosed with migraine were females (100%). According to the MS-QoL, the older group experienced a lower life quality score (61.8 ± 23.8) than the younger (78.6). The widowed group experienced the lowest score of all groups (33.3). Participants with chronic diseases experienced a lower QoL score (50.8 ± 19.4) than participants without (82.9 ± 4.9).

Table 3: MS-QOL in association with participants’ sociodemographic factors (n=23).

Discussion

Migraine is the second most frequent headache disorder in older persons, following tension-type headaches, with a one-year incidence of roughly 10% [7,15].

This cross-sectional study aimed to assess the burden of migraine among the elderly in Taif, Saudi Arabia, as well as to assess the effect of sociodemographic factors on migraine-specific quality of life among patients with migraine. The study included 75 participants, of which 30.7% were diagnosed with migraine using the screening tool.

All migraine-positive participants in our study were females (100%). In addition, there were almost three times subjects suffering from migraine in the older age group than in the younger. This is consistent with the literature. The clinical features of migraine alter with age [16] and as the ]number of comorbidities rises [13]. In a study of 260 migraine patients ranging in age from 3 to 69 years, significant variations in clinical aspects were found as patients became older [17]. From infancy to maturity, the proportion of males having migraines declined dramatically. The length of headaches, unilateral discomfort, pulsing sensations, light sensitivity, and noise sensitivity increases with age in females.

Our results show a significant decline in MS-QoL among participants who are still working than those who are retired (p=0.000). The aggravation of headache with physical exercise, on the other hand, is reduced with age [17]. In the elderly, neck discomfort is associated with acute migraine headaches [18]. Other research has shown that as patients become older, autonomic symptoms such as tachycardia, sweating, dry mouth, and face flush increase, whereas sensory sensitivity, nausea, and vomiting decrease [12]. As a result, migraine therapy choices for older people are complicated and difficult, which is exacerbated by the exclusion of older patient groups (>65 years) from the bulk of migraine clinical studies [19].

Chronic headaches (chronic migraine, chronic tension headaches, and drug overuse headaches) afflict 5 to 22% of the aged population, according to studies, and are more common in women [12,20]. Headaches affect 14.9 percent of female patients and 6.1 percent of male patients who see their medical practitioner in Australia [21]. Headaches are the tenth most frequent symptom among elderly women and the fourteenth most common symptom among senior men worldwide [22]. Headache has the potential to degrade the quality of life and interfere with daily activities at home and in the community, resulting in a considerable burden of impairment [23].

Although specific primary headaches, such as hypnic headache and primary cough headache, are more common in the elderly, the frequency and incidence of primary headaches declines with age [11-13].

Conclusion

Our study revealed that migraine is more prevalent among female elderly than in comparable populations. Lower migraine-specific quality of life scores was evident among older age groups, residents of rural areas, widows, and illiterates, participants with chronic diseases and participants who are still working.

Acknowledgment

The authors would like to thank Abdalla Mohamed Bakr Ali, Faculty of Medicine, Sohag University for his contribution to the statistical analysis.

Author Contributions

Authors contributed equally in study implementation as well as data collection and manuscript writing.

Funding

This study has not received any external funding.

Conflict of Interest

The authors declare that there are no conflicts of interests.

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