Profile of Migraine Patients in a Developing Country: a Multicentre Study

Abstract

Migraine is a common headache disorder with significant impact on quality of life. Despite the significant progress in treatment and understanding of migraine, the care of sufferers is inadequate in low resource settings. Studies on characteristics of migraine patients receiving care in sub-Saharan Africa are limited. We aim to determine the effect of demographic characteristics on migraine diagnosis, and the adequacy of treatment offered in tertiary hospitals. This was a multi-centre, hospital-based, cross-sectional study conducted over 4 months in Northeast Nigeria. Participants were patients with known migraine on follow up at the neurology outpatient clinics. The sociodemographic, clinical records, and treatment outcome of each subject was documented. Of the 112 migraineurs who fulfilled the inclusion criteria, 104 consented to participate in the study. The mean age of the participants was 30.8 ± 10.4 years. Females constituted 74% of subjects, with a female to male ratio of 2.9:1. The difference between the mean age of migraine onset and the mean age at diagnosis was 4.6 years. On multivariate logistic regression analysis, age at headache onset (p = 0.001) and lower level of education (p = 0.03) independently predicted a delay in diagnosis of migraine. At first specialist clinic visit, 69.2% of the subjects had only a diagnosis of chronic migraine, 25% was additionally diagnosed with medication overuse headache, and about 92% was not placed on migraine preventive medication for their headaches despite meeting the criteria. Fifty-five (52.9%) patients had clinic visits in the past 12 months, among which prophylactic medications were used by 26 (45.1%) patients, while 13 (23.6%) were not adherent to preventive drug treatment, and 16 (29%) patients used their preventive medications as acute treatment. The significant delay from headache onset to migraine diagnosis has resulted in a more prevalent presentation with chronic migraine headache. Younger age at migraine onset and low educational attainment may affect diagnosis and treatment. The low prescription rate of migraine prophylactic medications by practitioners in this region may be affecting the quality of life of migraineurs.