Although, a door-to-door approach in estimating the prevalence of migraine is difficult and time consuming, it is more accurate than hospital-based studies as the majority of patients do not seek medical advice for self-limited paroxysmal disorders [12, 13]. Moreover, personal interview by a neurologist is better than diagnoses based on self-assessment by patients through questionnaires, as it is devoid of any recall bias and is more sensitive to detect comorbidities [13]. In the present study, the lifetime prevalence rate of migraine was 3.38%, with the highest figure (4.77%) found among young adults (18 to < 40 years). Migraine prevalence in the current study is near the global data of WHO estimates which mentioned that migraine appears somewhat less prevalent, but still common, in Asia (3% of men and 10% of women) and in Africa (3–7% in community-based studies) [14]. However, epidemiological studies had shown that migraine seems to be more prevalent in Europe (14.8%) and North America (11.1%) than it is in Africa (4%) [15]. Although numerous studies of migraine prevalence have been published, reviews of the epidemiological literatures have shown large variation in the prevalence rates, which is mostly explained by differences in socio-demographic profiles of the study subjects, survey methods, and case definition [6, 7, 11, 16].
In the present study, migraine was found to be more prevalent among females (4.8%) than males (1.95%) with male to female ratio of 1:2.5, and this was more obvious around puberty (12 to < 18 years) where male prevalence was 1.26 while female prevalence was 3.9 as mentioned in Table 1. Increased prevalence of migraine among females around puberty could be attributed to hormonal differences particularly related to the newly encountered menstrual cycles, a condition referred to as estrogen-withdrawal headache by the International Classification of Headache Disorders (ICHD) [2, 17].
As regards the age-specific prevalence among different age groups, we found that the youngest recorded case of migraine was 6 years. Prevalence then increases steadily to reach its peak at young adults (18 to < 40 years) and then declines again at late adult life (Table 1). These results are partially consistent with most studies on migraine prevalence, which have reported variation among different age groups, with prevalence figures following an inverted U-shaped distribution, increasing from age 15 to 18, peaking during the third and early fourth decades of life and declining thereafter [18, 19].
In the present study, migraine without aura (57%) was more common than migraine with aura (34%). This was in agreement with Houinato et al. [20] and Zivadinov et al. [21] who found that migraine without aura was the most frequent form (67.5% and 62% respectively).
The MIDAS may provide a practical tool to understand the impact of migraine and suggest treatment recommendation [22]. Among studied migraineurs, it was found that about 2/3 (68%) of patients had moderate (26% grade III) to severe disability (42% grade IV) (Table 3). These findings are consistent with the Global Migraine and Zolmitriptan evaluation (MAZE) survey, which states that the migraine patients with grade III or IV was found to be as 54% in France, 47% in England, 48% in Germany, 56% in the USA, and 61% in Italy [23].
Furthermore, besides this severe disability finding, all migraineurs in the present study reported moderate to severe intensity of their migraine attacks. Despite this marked disability and its impact on daily activity of migraineurs, particularly during their reproductive age period (18–40 years), prophylactic treatment was only administered by 8.5% of patients. This yields a very wide treatment gap of 91.5%. This heavy burden of migraine disability, besides the very wide treatment gap, might throw some light on this major health problem and necessitates more public awareness and the need for prophylactic treatment.
The determination of migraine treatment gap is vital for health care planning, both on a public health level and an individual level. This treatment gap is a major cause of suffering and contributes to the socioeconomic burden of the disease. In the present study, treatment gap is 91.5%.
