Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
Headache. 2013 Feb;53(2):310-21. doi: 10.1111/j.1526-4610.2012.02259.x. Epub 2012 Oct 23.
Despite being a highly prevalent disorder and substantial cause of disability, migraine is understudied in Africa. Moreover, no previous study has investigated the effects of stress and unipolar psychiatric comorbidities on migraine in a sub-Saharan African cohort.
To evaluate the prevalence of migraine and its association with stress and unipolar psychiatric comorbidities among a cohort of African adults.
This was a cross-sectional epidemiologic study evaluating 2151 employed adults in sub-Saharan Africa. A standardized questionnaire was used to identify sociodemographic, headache, and lifestyle characteristics of participants. Migraine classification was based on the International Classification of Headache Disorders-2 diagnostic criteria. Depressive, anxiety, and stress symptoms were ascertained with the Patient Health Questionnaire and the Depression Anxiety Stress Scale, respectively. Multivariable logistic regression models were used to estimate adjusted odds ratio (OR) and 95% confidence intervals (CIs).
A total of 9.8% (n=212) of study participants fulfilled criteria for migraine (9.8%, 95% CI 8.6-11.1) with a higher frequency among women (14.3%, 95% CI 11.9-16.6) than men (6.9%, 95% CI 5.5-8.3). Similar to predominantly Caucasian migraine cohorts, sub-Saharan African migraineurs were more likely to be younger, have a lower education, and more likely to report a poor health status than non-migraineurs. However, in contrast with historical reports in predominantly Caucasian migraine cohorts, sub-Saharan African migraineurs were less likely to report smoking than non-migraineurs. Participants with moderately severe depressive symptoms had over a 3-fold increased odds of migraine (OR=3.36, 95% CI 1.30-8.70) compared with those classified as having minimal or no depressive symptoms, and the odds of migraine increased with increasing severity of depressive symptoms (P trend<0.001). Similarly, those with mild, moderate, and severe anxiety symptoms had increased odds of migraine (OR=2.28, 95% CI 1.24-4.21; OR=1.77, 95% CI 0.93-3.35; and OR=5.39, 95% CI 2.19-13.24, respectively). Finally, those with severe stress had a 3.57-fold increased odds of migraine (OR=3.57, 95% CI 1.35-9.46).
Although historically it has been reported that migraine prevalence is greater in Caucasians than African Americans, our study demonstrates a high migraine prevalence among urban-dwelling Ethiopian adults (9.9%) that is comparable with what is typically reported in predominantly Caucasian cohorts. Further, among employed sub-Saharan African adults and similar to predominantly Caucasian populations, migraine is strongly associated with stress and unipolar psychiatric symptoms. The high burden of migraine and its association with stress and unipolar psychiatric symptoms in our study of well-educated and urban-dwelling African adults has important clinical and public health implications pending confirmation in other African populations.
尽管偏头痛是一种高发疾病，也是导致残疾的主要原因之一，但在非洲，对偏头痛的研究却很少。此外，以前没有研究调查过压力和单相精神共病对撒哈拉以南非洲队列偏头痛的影响。
评估偏头痛在撒哈拉以南非洲成年人中的流行程度及其与压力和单相精神共病的关系。
这是一项横断面流行病学研究，评估了撒哈拉以南非洲的 2151 名在职成年人。使用标准化问卷确定参与者的社会人口学、头痛和生活方式特征。偏头痛的分类基于国际头痛疾病分类-2 诊断标准。抑郁、焦虑和压力症状分别通过患者健康问卷和抑郁焦虑压力量表确定。使用多变量逻辑回归模型估计调整后的优势比（OR）和 95%置信区间（CI）。
共有 9.8%（n=212）的研究参与者符合偏头痛标准（9.8%，95%CI 8.6-11.1），女性（14.3%，95%CI 11.9-16.6）的频率高于男性（6.9%，95%CI 5.5-8.3）。与主要为白种人偏头痛队列相似，撒哈拉以南非洲偏头痛患者比非偏头痛患者更年轻、受教育程度更低、健康状况更差。然而，与主要为白种人偏头痛队列的历史报告不同，撒哈拉以南非洲偏头痛患者报告吸烟的比例低于非偏头痛患者。中度严重抑郁症状患者偏头痛的优势比（OR）为 3.36（95%CI 1.30-8.70），明显高于轻度或无抑郁症状患者，并且随着抑郁症状严重程度的增加，偏头痛的几率增加（趋势 P<0.001）。同样，轻度、中度和重度焦虑症状患者偏头痛的优势比（OR=2.28，95%CI 1.24-4.21；OR=1.77，95%CI 0.93-3.35；OR=5.39，95%CI 2.19-13.24）分别增加。最后，严重压力组偏头痛的优势比（OR）为 3.57（95%CI 1.35-9.46）。
尽管历史上报告偏头痛的患病率在白种人高于非裔美国人，但我们的研究表明，埃塞俄比亚城市居民偏头痛的患病率很高（9.9%），与主要为白种人队列中报告的患病率相当。此外，在撒哈拉以南非洲的在职成年人中，偏头痛与压力和单相精神症状密切相关，这与主要为白种人的人群相似。我们对受过良好教育和居住在城市的非洲成年人进行的这项研究表明，偏头痛负担很高，并且与压力和单相精神症状有关，这具有重要的临床和公共卫生意义，有待在其他非洲人群中得到证实。
