Laboratory of Clinical and Experimental Neuroscience, Faculty of Medicine, Cadi Ayyad University, Marrakech, Morocco.
Department of Neurology, Mohammed VI University Hospital, Marrakech, Morocco.
J Headache Pain. 2024 Apr 3;25(1):49. doi: 10.1186/s10194-024-01761-y.
The series of population-based studies conducted by the Global Campaign against Headache has, so far, included Pakistan and Saudi Arabia from the Eastern Mediterranean Region. The Maghreb countries of North Africa, also part of this Region, are geographically apart and culturally very different from these countries. Here we report a study in Morocco.
We applied the standardised methodology of Global Campaign studies, with cluster-randomized sampling in regions of Morocco selected to be representative of its diversities. In three of these regions, in accordance with this methodology, we made unannounced visits to randomly selected households and, from each, interviewed one randomly selected adult member (aged 18-65 years) using the HARDSHIP structured questionnaire translated into Moroccan Arabic and French. In a fourth region (Fès), because permission for such sampling was not given by the administrative authority, people were randomly stopped in streets and markets and, when willing, interviewed using the same questionnaire. This was a major protocol violation.
We included 3,474 participants, 1,074 (41.7%) from Agadir, 1,079 (41.9%) from Marrakech, 422 (16.4%) from Tétouan and 899 from Fès. In a second protocol violation, interviewers failed to record the non-participating proportion. In the main analysis, excluding Fès, observed 1-year prevalence of any headache was 80.1% among females, 68.2% among males. Observed 1-day prevalence (headache yesterday) was 17.8%. After adjustment for age and gender, migraine prevalence was 30.8% (higher among females [aOR = 1.6]) and TTH prevalence 32.1% (lower among females [aOR = 0.8]). Headache on ≥ 15 days/month (H15+) was very common (10.5%), and in more than half of cases (5.9%) associated with acute medication overuse (on ≥ 15 days/month) and accordingly diagnosed as probable medication-overuse headache (pMOH). Both pMOH (aOR = 2.6) and other H15+ (aOR = 1.9) were more common among females. In the Fès sample, adjusted prevalences were similar, numerically but not significantly higher except for other H15+.
While the 1-year prevalence of headache among adults in Morocco is similar to that of many other countries, migraine on the evidence here is at the upper end of the global range, but not outside it. H15 + and pMOH are very prevalent, contributing to the high one-day prevalence of headache.
全球头痛防治运动开展的一系列基于人群的研究，目前已包括中东地中海地区的巴基斯坦和沙特阿拉伯。北非的马格里布国家也是该地区的一部分，与这些国家在地理上相距甚远，文化上也大不相同。在此，我们报告摩洛哥的一项研究。
我们采用全球头痛防治运动研究的标准化方法，在摩洛哥选择具有代表性的地区进行聚类随机抽样。在其中三个地区，根据该方法，我们对随机选择的家庭进行了突击访问，并从每个家庭中选择一名随机选择的成年成员（18-65 岁），使用翻译成摩洛哥阿拉伯语和法语的 HARDSHIP 结构化问卷进行访谈。在第四个地区（非斯），由于行政当局未批准此类抽样，因此在街上和市场随机拦下人们，并在他们愿意的情况下使用相同的问卷进行访谈。这是一个主要的违反协议的行为。
我们共纳入 3474 名参与者，其中来自阿加迪尔的有 1074 人（41.7%），来自马拉喀什的有 1079 人（41.9%），来自丹吉尔的有 422 人（16.4%），来自非斯的有 899 人。在第二个违反协议的行为中，访谈员未能记录未参与的比例。在主要分析中，排除非斯的数据后，观察到女性中任何头痛的 1 年患病率为 80.1%，男性中为 68.2%。观察到 1 天的患病率（昨天头痛）为 17.8%。在调整年龄和性别后，偏头痛的患病率为 30.8%（女性更高[aOR=1.6]），紧张型头痛的患病率为 32.1%（女性更低[aOR=0.8]）。每月头痛≥15 天（H15+）非常常见（10.5%），其中超过一半（5.9%）与急性药物过度使用有关（每月≥15 天），并因此诊断为可能的药物过度使用性头痛（pMOH）。pMOH（aOR=2.6）和其他 H15+（aOR=1.9）在女性中更为常见。在非斯的样本中，调整后的患病率相似，除了其他 H15+外，数值上较高，但无统计学意义。
虽然摩洛哥成年人头痛的 1 年患病率与许多其他国家相似，但这里的偏头痛证据表明处于全球范围内的较高水平，但并未超出范围。H15+和 pMOH 非常普遍，导致头痛的 1 天患病率较高。
