A recent review highlighted that being female is a demographic risk factor for migraines. Women experience migraines approximately twice as often as men, influenced by biological, psychological, and hormonal factors. For instance, a review of 12 studies found that elevated estrogen levels, substantial changes in estrogen, and hormone replacement therapy are associated with the most severe migraine outcomes (14).
Further studies at regional and national levels have identified a significant sex difference in the prevalence of headache conditions, with females being three times more susceptible than males. The impact of migraines also increases with age, peaking among individuals aged 30 to 39 (15). In alignment with previous findings, our study demonstrated a clear predominance of females, approximately three times that of males. Our findings also suggested that migraines are more likely to manifest during youth, as supported by a review indicating that the peak incidence occurs during the most productive years, with 90% of migraineurs experiencing their first episode before age 40 (10).
Hormonal fluctuations play a significant role in the development of migraines, as shown by a study on individuals aged 15–39, which reported that puberty and menarche mark a significant increase in headache disorders among women. Additionally, urbanization, healthcare access, and air quality were identified as contributing factors to the rising number of headaches among the young population (15). A recent review on migraine global epidemiology found no clear association between migraine burden and socioeconomic status, consistent with our study's findings (14).
The various scores used in our research to explore demographic factors and comorbidities associated with migraines indicate that there are bidirectional relationships among BMI, fatigue, anxiety levels, reduced quality of life, and migraines. Epidemiological research suggests a link between migraine and several systemic issues like depression, anxiety, irritable bowel syndrome, fibromyalgia, sleep disturbances, chronic fatigue, and cognitive impairments. These coexisting conditions are seen as painless manifestations of migraine that can occur before, during, or after a headache. Studies have shown changes in brain activity beyond the pain network, occurring hours to days before a migraine attack and continuing after the headache resolves. This suggests that alleviating migraines could potentially improve these additional symptoms in some cases (16).
In a Canadian study involving 36,000 individuals, it was found that anxiety affects 50% of migraine sufferers throughout their lives, and around 60% experience abnormal levels of fatigue (16). Research consistently shows a significant bidirectional link between migraines and mental health issues, with individuals with migraines being more likely to experience anxiety than the general population. Anxiety can lead to negative clinical outcomes and difficulties in treatment response, and it may be linked to a diminished Health-Related Quality of Life (HRQoL) in adults with migraines (17). Another study confirmed that many individuals with migraines face significant levels of disability, with half experiencing considerable disability for 16 or more days annually (18).
Our findings also indicate that fatigue, migraine indicators, and anxiety levels vary between genders, with women experiencing more pronounced fatigue and anxiety, while men score higher in other assessments. According to the Migraine in America Symptoms and Treatment (MAST) study, male gender, marital status, employment, and higher household income are associated with reduced anxiety risk, while anxiety odds increase among younger age brackets (23–34, 35–44, 45–54) and decrease for those aged 65 and older (19).
Research on gender differences in anxiety disorders among teenagers found that earlier onset age and longer duration of episodes could explain higher rates of anxiety disorders in females. The study proposed that genetic or biological distinctions, rather than environmental factors alone, might account for these differences (20). Another study emphasized the role of hormonal changes in increased anxiety levels in females, particularly related to menstruation and reproductive phases, with anxiety peaking during the late luteal phase and pregnancy. Adolescent girls also experience more anxiety and are more prone to generalized anxiety disorder compared to boys (21).
Further research into gender differences in depression and anxiety throughout adulthood revealed significant patterns with advancing age, with fewer notable contributing factors for these differences (22). However, there is no definitive proof in the existing literature that males exhibit higher Migraine-Specific Quality of Life Questionnaire (MSQ) Total Scores compared to females. Some studies have explored factors that directly impact quality of life, such as the meaning of life, which correlates with quality of life through pain self-efficacy (23).
Gender differences in fatigue are well documented. A systematic review and analysis of fatigue demographics in the global general population found a higher prevalence of fatigue in females compared to males, possibly due to an inflammatory model suggesting that females may be more susceptible to immune-related behavioral changes, such as fatigue, mood disturbances, and heightened pain sensitivity. Poor mental health and gender disparities might also contribute significantly to this disparity (24). Research involving 10,000 women identified psychological distress, insomnia, and somatic illness as primary factors linked to daytime tiredness and exhaustion in women, with 21% experiencing sleepiness, fatigue, or both (25).
Consistent with previous research, our study found a preference for urban areas among people with migraines. These findings may have implications for tailoring healthcare programs and support systems. By categorizing urbanization into five groups, a study clarified the connection between urban living and the frequency of mental health issues, confirming that psychiatric disorders are more prevalent and complex in highly urbanized regions (26). Another study found a positive correlation between urban green spaces and human welfare, emphasizing the benefits of green areas in enhancing well-being (27).
In our research, we acknowledge certain limitations, like non-response bias. This bias can lead to a skewed response rate among individuals experiencing more pronounced symptoms. This type of bias is particularly prevalent in data gathered via mailed surveys or questionnaires. Nevertheless, our study boasts numerous strengths. By encompassing 679 migraine sufferers across different age groups, it offers a comprehensive view of the findings. Additionally, it explores the correlations between various factors like fatigue, anxiety, and quality of life and their association with migraines while examining these connections across genders. Which will fill a significant gap in the existing Syrian literature.