Prevalence of Migraine in Medical Students of Dubai Medical College, UAE

doi:10.21203/rs.3.rs-1256684/v1

Aim: To assess the prevalence of migraine in students at Dubai Medical College, UAE.

Material Methods: A cross-sectional questionnaire-based study was undertaken for three months between December 2020 and February 2021, in Dubai Medical College for Girls, UAE.

Results: The students from the first to the final year of MBBS participated in the study. (n=147) Thirty seven percent of the students from this sample size are giving a history of migraine. Family history of migraine is noted in forty five percent of students from this sub-group. The duration of migraine history is between one to five years in nearly sixty two percent of them with a duration of one to five hours and occurring at a frequency of one episode per week in the maximum number of students with a history of migraine. Fifty eight percent of the students experienced an aura preceding the migraine attack, while forty-two percent of the students had no preceding aura. Lack of sleep, examination and physical stress and psychological factors (anxiety, depression, anger) constituted the main triggering factors for the migraine attacks. Conversely, adequate sleep, rest medication (analgesics) and coffee were the salient relieving factors. The students were suffering from mild to moderately severe migraine predominantly, while not many of them had severe migraine. Associated illness in the form of anxiety, allergic rhinitis and polycystic ovarian disease was noted in some of the students with migraine. Medical advice for the migraine was obtained by a very small number of the students.

Conclusion: Headache of migraine can have a detrimental effect on a student’s life both personally and professionally. Measures avoiding triggering factors, prophylactic drug treatment and launching of migraine awareness programs at high school levels would all be greatly beneficial in alleviating the student’s headache and halting its progress to a chronic illness; thereby influencing a student’s quality of life remarkably

Head & Neck Surgery

Migraine

Triptans

Headache

Migraine presents as a pulsatile, throbbing type of headache with poorly understood etiology. It is reported in 10 to 15% of worldwide population has a familial occurrence and is more common in women. (1) Headache has a tremendous impact on a person’s life. The episodic form of migraine if not properly treated can transform to chronic form. (2) Patients with severe migraine report one to five attacks per month of moderate to severe unilateral pain. It is often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for hours to days and the headache significantly affects quality of life resulting in considerable health care costs. Migraine almost certainly has a genetic basis, but environmental factors play a significant role in its occurrence. Management of headache involves avoidance of triggers of headache (alcohol, chocolate, and stress) and use of abortive treatments as well as prophylactic therapy for acute headache in patients with frequent or severe migraine. (3)

Prevalence of migraine in university students has shown to vary from 12.6 to 48%. (4) Students form one of the most common victims of stress in the general population.

Stress also depends on the level of education of the students. Medical education involves a college study of not less than five years. Medical students are exposed to a high level of stress during their medical training and are overloaded with tremendous amount of information. Several studies related to migraine have been performed on medical students as the target population. However, there is a scarcity of the data on headache epidemiology in UAE and the current study was conducted as the first epidemiological

study to evaluate migraine and its associated factors among medical students in Dubai medical students.

Aim

To assess the prevalence of migraine in students at Dubai Medical College, UAE.

A cross-sectional questionnaire-based study was undertaken for three months between December 2020 and February 2021, in Dubai Medical College for Girls, UAE. The students from the first to the final year of MBBS (n=147) participated in the anonymous survey after prior consent and approval from the Research and Ethical Committee at Dubai Medical College. The questionnaire included the demographics, trigger factors, relieving and exacerbating factors, associative illness, family history, duration, and severity of migraine to analyze its prevalence among medical students.

This study includes a sample size of 147 students from first to the final year in Dubai Medical College for Girls, UAE. Thirty seven percent of the students from this sample size are giving a history of migraine. (Table 1)

Table 1 History of Migraine

n=147
History of Migraine	n	Percentage of Students
Positive history	55	37.4 %
Negative history	92	62.6%

Family history of migraine is noted in forty five percent of students from this sub-group. (Table 2)

Table 2 Family History of Migraine 

n=55
Family History of Migraine	Percentage
Positive	45% (25)
Negative	29% (16)
Not Sure	25 % (14

The duration of migraine history is between one to five years in sixty two percent of them with a duration of one to five hours and occurring at a frequency of one episode per week in the maximum number of students with a history of migraine. (Table 3)

Table 3 Duration of Migraine History

n=55
<1 year	40 % (22)
1-5 years	32% (26)
6-10 years	10 % (5)
11-15 years	7% (2)

Fifty eight percent of the students experienced an aura (nausea/vomiting, sensitivity to light and sound, vertigo, flashes of light) preceding the migraine attack, while forty-two percent of the students had no preceding aura. (Table 4)

Table 4 Migraine Associated with Aura  

n=55
Students with preceding symptoms	Students without preceding symptoms
58.2% (32)	41.8 % (23)
Vomiting, nausea, photophobia, phonophobia, vertigo, flashes of light

Lack of sleep, examination and physical stress and psychological factors (anxiety, depression, anger) constituted the main triggering factors for the migraine attacks. Conversely, adequate sleep, rest medication (analgesics) and coffee were the salient relieving factors. (Table 5 &6)

Table 5

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Table 6

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The students were suffering from mild to moderately severe migraine predominantly, while not many of them had severe migraine. (Table 7)

Table 7 Severity of Migraine 

Mild

[<1 attack per month, lasts up to 8hours, no incapacitation]

47.3% (27)

Moderate

[One or more attacks per month, lasting 6 – 24 hours, mild incapacitation with prominent nausea/vomiting

40% (22)

Severe

(2-3 or more attacks per month, lasting 12-48 hours (about 2 days), associated with vertigo, vomiting & other symptoms)

incapacitation present during attack,

12.7% (6)

Associated illness in the form of anxiety, allergic rhinitis and polycystic ovarian disease was noted in some of the students with migraine. (Table 8)

Table 8

Associated Illness with Migraine

n=55
Anxiety	80 %
Allergic rhinitis	46.7%
Bronchial asthma	13.3%
Epilepsy	1.36%

Medical advice for the migraine was obtained by an exceedingly small number of students. (Table 9)

Table 9 Students Seeking Medical Advice for Migraine

n=55
No	84.4%
Yes	15.6%

Our study shows thirty seven percent of medical students studying in Dubai Medical University to be suffering from migraine which is comparable to previous studies showing a prevalence between thirty-three to ninety eight percent in medical students and having a preponderance of female students too. (4–8) The difference might relate to low or no alcohol use in UAE, compared to other countries.

Migraine headaches are of two main types and can occur with or without aura. The headache in both types is similar and women are affected three times more than men. (9) It is noted that majority of the students (75%) had migraine without any preceding aura and only 25% of the migraine cases were accompanied by aura comprising of photophobia, phonophobia and vomiting which is consistent with the previous studies. (10) Vertigo was reported in a small percentage of students as an associated symptom which raises the possibility of vertiginous migraine. (11) Vestibular migraine is the second common cause of vertigo and a common cause of vertigo.

Anxiety was the prominent associated illness followed by allergic rhinitis in the affected students. Anxiety and mood disorders have been shown to be the most relevant psychiatric comorbidities associated with migraine, influencing its clinical course, treatment response, and clinical outcomes. Previous studies have shown lack of ability to properly control worrying and to relax as the most prominent issues in migraine psychiatric comorbidity. (12) Studies have shown a high prevalence of migraine headaches in patients with allergic rhinitis compared to those without. Histamine and other allergic mediators could play a key role in the pathogenesis of migraine headaches by way of vasodilatation and inflammation. This study has also demonstrated an association between allergic rhinitis and migraine in a small group of the affected students. (13)

The duration of history of migraine is reported to be between one to five years in a predominant number of the subgroup. This indicates that the symptoms of migraine would have started to

appear in the students during their high school or immediately after commencement of their medical education as the study sample included medical graduates from the first to the final year. This implies the significant role of stress responsible for the migraine, as during this phase of their life they worry about meeting academic demands, pleasing parents and teachers, and keeping up with their classmates.

Majority of the students of this study were suffering from mild to moderately severe migraine. Conversely, severe headaches were observed in only a few of the students. Lack of sleep, stress and exams were the major factors responsible for the initiation of migraine attacks. Studies have demonstrated sleep disruption to be a trigger of migraine attacks, which are improved with sufficient restful sleep. Typically, people with chronic migraine are prone to morning headaches due to insufficient sleep. (14 –16) Stress due to any cause (emotional/examination) can be a triggering factor for migraine. Stress cannot be avoided during student life; however, it must be

kept under control. Measures like proper diet, exercises, time management, positive attitude and taking a break can be very helpful in relieving stress which is also observed in our study.

Family history of migraine is markedly noted in this study. Migraine headaches generally show a multifactorial inheritance pattern, but the specific nature of the genetic influence is not yet completely understood. Approximately seventy percent of patients have a first-degree relative with a history of migraine. The risk of migraine is increased four-fold in relatives of people who have migraine with aura. (17)

Headache of migraine can have a detrimental effect on a person’s life both personally and professionally. Students with mild to moderately severe migraine constituted the preponderant group of students in this study. Measures like sufficient sleep, time management, proper diet, exercises, can be very beneficial in alleviating their headache and halting its progress to a chronic illness; thereby influencing students’ quality of life remarkably. Prophylactic treatment with triptans, beta blockers, antidepressants, and antipsychotic drugs, would go a long way in bringing down the frequency and severity of the migraine attacks. Launching of Migraine Awareness Programs at high school levels would also exert a favorable influence on the students’ academic as well as social life.

Srivastava SK A Complete Textbook of Medical Pharmacology. Ch. 16. Pg. 245
Prevalence and characteristics of migraine in medical students and its impact on their daily activities. Bindu Menon and Neeharika Kinnera
Lippincott’s Pharmacology 6th Edition. Ch 36 Eric Dietrich, Nicholas Carris, Thomas A. Panavelil p465
Smitherman TA, McDermott MJ, Buchanan EM (2011) Negative impact of episodic migraine on a university population: Quality of life, functional impairment, and comorbid psychiatric symptoms. Headache 51:581–589
Souza-e-Silva HR, Rocha-Filho PA (2011) Headaches, and academic performance in university students: A cross-sectional study. Headache 51:1493–1502
Da Costa MZ, Soares CB, Heinisch LM, Heinisch RH (2000) Frequency of headache in the medical students of Santa Catarina’s Federal University. Headache 40:740–744
Sanvito WL, Monzillo PH, Peres MF, Martinelli MO, Fera MP, Gouveia DA et al (1996) The epidemiology of migraine in medical students. Headache 36:316–319
Deleu D, Khan MA, Humaidan H, Al Mantheri Z, Al Hashami S (2001) Prevalence, and clinical characteristics of headache in medical students in oman. Headache 41:798–804
Lippincott’s Pharmacology 6th Edition. Ch 36 Eric Dietrich, Nicholas Carris, Thomas A Panavelil. Pg.465-67
Bokhari FA, Sami W, Shakoori TA, Ali SA, Qureshi GA (2008) Clinical characteristics of 226 college-going female migraineurs in Lahore, Pakistan - putting ICHD-2 to the road test. NeuroEndocrinolLett 29:965–970
Prevalence and characteristics of migraine in medical students and its impact on their daily activities Bindu Menon and Neeharika Kinnera
J Headache Pain (2017) ; 18(1):37. Published online 2017 Mar 21.
Journal of Allergy and Clinical Immunology:The prevalence of migraine headaches in patients with allergic rhinitis
Kelman L, Rains JC (2005) Headache and sleep: examination of sleep patterns and complaints in a large clinical sample of migraineurs. Headache 45:904–910
Alberti A (2006) Headache and sleep. Sleep Med Rev 10:431–437
Sahota P (2003) Morning headaches in patients with sleep disorders. Sleep Med 4:377
Kors EE, Haan J, Ferrari MD Genetics of Primary Headache.Current Opinion Neur. 1999 Jun. 12(3):249–54

Prevalence of Migraine in Medical Students of Dubai Medical College, UAE

Status:

Version 1

Abstract

Introduction

Material And Methods

Results

Discussion

Conclusion

References

Status:

Version 1