The clinical properties of a Migrainous population in Eastern Turkey-Erzurum.Objectives: The purpose of this study was to determine the clinical and demographic characteristics of patients with migraine headache Migraine Headache Definition
Migraine is a type of headache marked by severe head pain lasting several hours or more.
Migraine is an intense and often debilitating type of headache. , in the vicinity of Erzurum, Turkey.
Methods: A uniform questionnaire was given to 185 patients diagnosed as having migraine migraine (mī`grān), headache characterized by recurrent attacks of severe pain, usually on one side of the head. It may be preceded by flashes or spots before the eyes or a ringing in the ears, and accompanied by double vision, nausea, according to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. the International Headache Society The International Headache Society (IHS) is a charity organisation founded in 1981 for people from all professions that are working to treat headache disorders.
It has over 1,000 ordinary members (including national society members). diagnostic criteria between August 2001 and July 2002. One hundred forty five females (78.4%) and 40 males (21.6%) were included in the study. The male to female ratio was 1:3.2. The mean age of the cases was 32.4 [+ or -] 10.2 years and the mean age of onset The age of onset is a medical term referring to the age at which an individual acquires, develops, or first experiences a condition or symptoms of a disease or disorder.
Diseases are often categorized by their ages of onset as congenital, infantile, juvenile, or adult. was 22.8 [+ or -] 9.1 years.
Results: One hundred and thirty seven patients (74.6%) fulfilled the criteria for migraine without aura migraine without aura,
n See common migraine. (MwA) whereas forty-eight patients (25.4%) fulfilled the criteria for migraine with aura migraine with aura,
n See classic migraine. (MA). The males had been suffering from migraine headaches for a mean of 8.3 [+ or -] 6.3 years versus a mean of 9.3 [+ or -] 7.6 years in females. More than half (61.4%) of the females were housewives, and 84.3% of the cases were living in urban areas. About half (48.7%) of them had at least 11 years of education, most (79.5%) reported low or medium income level. Also, 70.8% were married. There was a high rate of headache in family history (72.4%). A majority of patients (75.7%) complained of severe headaches. One fourth (24.9%) had more than three attacks per month. Headache was unilateral in 71.9% and was throbbing throb
intr.v. throbbed, throb·bing, throbs
1. To beat rapidly or violently, as the heart; pound.
2. To vibrate, pulsate, or sound with a steady pronounced rhythm: in 77.8%. In 117 patients (63.2%) the symptoms were aggravated ag·gra·vate
tr.v. ag·gra·vat·ed, ag·gra·vat·ing, ag·gra·vates
1. To make worse or more troublesome.
2. To rouse to exasperation or anger; provoke. See Synonyms at annoy. by physical activity. Attacks were accompanied by nausea in 84.9%, vomiting vomiting, ejection of food and other matter from the stomach through the mouth, often preceded by nausea. The process is initiated by stimulation of the vomiting center of the brain by nerve impulses from the gastrointestinal tract or other part of the body. in 50.3%, photophobia photophobia /pho·to·pho·bia/ (-fo´be-ah) abnormal visual intolerance to light.photopho´bic
1. in 80.0%, and phonophobia in 78.4%. In 58% of the cases, the headache was severe enough to disturb daily activities.
Conclusions: This study showed that migraine is more commonly seen in urban areas, in females, and is associated with high education plus low income, and is comprised of a wide complex of symptoms.
Key Words: clinical properties, migraine, sociodemographic characteristics
Migraine is a common disease. The life-term prevalence of migraine is 10% for males and 25% for females. (1-6) The purpose of this study was to determine the clinical profile of patients with migraine who live in the vicinity of Erzurum.
Materials and Methods
This prospective study was conducted on patients diagnosed as having migraine according to International Headache Society (IHS IHS
(I.H.S.) first three letters of Greek spelling of Jesus; also taken as acronym of Iesus Hominum Salvator ‘Jesus, Savior of Mankind.’ [Christian Symbolism: Brewer Dictionary, 480]
See : Christ
IHS ) diagnostic criteria, (7) and who were seen in the Neurology neurology (nrŏl`əjē, ny–), study of the morphology, physiology, and pathology of the human nervous system. Department outpatient clinics of Ataturk University, Faculty of Medicine, between August 2001 and July 2002. The patients' histories were taken and physical examinations were performed. Auxiliary examinations were performed when necessary. A questionnaire was administered to determine the demographic characteristics (age of headache onset, sex, level of education and income, type of migraine), clinical features of the migraine (frequency, duration, localization Customizing software and documentation for a particular country. It includes the translation of menus and messages into the native spoken language as well as changes in the user interface to accommodate different alphabets and culture. See internationalization and l10n. , and quality of headache), and coexisting co·ex·ist
intr.v. co·ex·ist·ed, co·ex·ist·ing, co·ex·ists
1. To exist together, at the same time, or in the same place.
2. symptoms (nausea, vomiting, photophobia, and phonophobia).
One hundred eighty-five patients with migraine were included; 145 (78.4%) were female and 40 (21.1%) were male. The male-to-female ratio was 1:3.2 and the age range was 8 to 64 years (mean age, 32.37 [+ or -] 10.16 years). Forty-seven (25.4%) were diagnosed as having migraine with aura (MA), and the remaining 138 (77.6%) as having migraine without aura (MwA). The mean age of headache onset was 21.9 [+ or -] 8.4 for MA and 23.1 [+ or -] 9.4 years for MwA (P > 0.05). The mean duration of migraine was 9.3 [+ or -] 7.6 years. There was no significant difference between MA and MwA groups in terms of age, sex, age of headache onset, and headache duration (Table 1).
The patients' sociodemographic characteristics are displayed in Table 2. It was observed that 37.3% of the females and 90% of the males had education for at least 11 years. Of all patients, 79.5% had low or medium income, and 20.5% had fair or high-income status. There was a significant difference between males and females according to the distributions of economic (P = 0.020), educational (P = 0.013), marital (P = 0.001), and occupational status (P = 0.000).
The clinical features of the headache attacks are presented in Table 3. Nausea was a significantly more frequent complaint reported by females than by males in the MwA group (P = 0.000). Again, when the males were compared among themselves, nausea (P = 0.012, MA > MwA) and vomiting (P = 0.009, MA > MwA) differed significantly. In the MA group, the auras were characterized as pure visual in 76.5%, both visual and sensorial sensorial /sen·so·ri·al/ (sen-sor´e-al) pertaining to the sensorium.
Of or relating to sensations or sensory impressions. in 23.5%, pure sensory in 5.9%, both visual and aphasic a·pha·sia
Partial or total loss of the ability to articulate ideas or comprehend spoken or written language, resulting from damage to the brain caused by injury or disease. in 5.9%, and pure motor auras in 2.9%. The prodromal prodromal
the stage of premonitory signs presaging the onset of disease or of specific clinical signs such as seizures. symptoms reported were unusual exhaustion (48%), mood alterations (47.4%), yawning yawning
a deep, involuntary inspiration with the mouth open, often accompanied by the act of stretching. Repeated yawning in the presence of other signs, may accompany signs of chronic abdominal pain or hepatic disease. (23.7%), and appetite for sweet foods (21.7%).
The common precipitating factors precipitating factor,
n the catalyst for an illness, symptom, or episode. This may not be the underlying cause of the illness, rather it is what elicits it. Also called
provoking factor. are listed in Table 4. The most common factors were stress/tension (70.8%), disturbances of sleep (48.6%), disturbances of eating (41.6%), and foods/drinks (32.9%). Also, during the pain-free periods, there was sensitivity to noise (42.2%) and glare (31.9%). Headache was precipitated during the menstrual menstrual /men·stru·al/ (men´stroo-al) pertaining to the menses or to menstruation.
men·stru·al or men·stru·ous
Of or relating to menstruation. periods in 31% of the female cases. In both sexes, fatigue was significantly more common in the cases without aura (P = 0.009, MwA > MA).
The onset of headache was during the awake state in 77%. Patients also had pain in the face and eye (40.8%) and in the neck (44.1%). Daily activities were disturbed by the headache "always" in 57.9%, and "occasionally" in 25% of the cases. In addition, 40.1% required bed rest (44.1% in cases of MA versus 39% in MwA, and 40.8% in the females versus 37.5% in the males).
Patients tried to cope with the headaches by taking analgesics Analgesics Definition
Analgesics are medicines that relieve pain.
Analgesics are those drugs that mainly provide pain relief. (75.7%), attempting to sleep in a dark, silent place (63.2%), physical/mental relaxation (44.1%), and massaging (19.1%).
Migraine is a neurologic neurologic /neu·ro·log·ic/ (-loj´ik) pertaining to neurology or to the nervous system.
Having to do with the nervous system. disease with a high prevalence. (1-6,8,9) A predominance pre·dom·i·nance also pre·dom·i·nan·cy
The state or quality of being predominant; preponderance.
Noun 1. predominance - the state of being predominant over others
predomination, prepotency of females is evident among those afflicted af·flict
tr.v. af·flict·ed, af·flict·ing, af·flicts
To inflict grievous physical or mental suffering on.
[Middle English afflighten, from afflight, . (10) In our series, the male-to-female ratio was 1:3.2. A change of the sex distribution with age can be seen. Until puberty puberty (py`bərtē), period during which the onset of sexual maturity occurs. , the prevalence of migraine in boys is equal to that of girls. Over 12 years of age, the prevalence is greater in females, reaching a peak between 25 to 40 years. Later, this ratio drops. The increase of migraine prevalence in females soon after menarche menarche /me·nar·che/ (me-nahr´ke) establishment or beginning of the menstrual function.menar´cheal
The first menstrual period, usually during puberty. suggests a possible initiator role of female sex hormones sex hormone
Any of various steroid hormones, such as estrogen and androgen, affecting the growth or function of the reproductive organs and the development of secondary sex characteristics. . (1,2,6,11-13) A similar female predominance has also been reported in field or outpatient clinic-based studies performed in our country. (8,9,14,15) This predominance is explained with a more common admission rate of females due to headache as a primary complaint. Also, it has been suggested that females are more sensitive and responsive to pain. (16)
The age of onset of migraine headaches is frequently (90%) lower than 50 years. There is a tendency to start at an earlier age in MA than MwA and in males than females. (11) In the childhood period, the peak age of onset is between 10 to 12 years in males and 14 to 16 years in females. (17,18) Steiner et al (19) have found the onset to be after the age of 40 in 8% of 479 patients, and they have reported that when headache starts after the age of 40, other potential causes should be excluded. In our study, the mean age of headache onset was 22.8 [+ or -] 9.1 years, and after the age of 40 it was only 3.9%. These cases did not have any other causes of headache.
MA was detected in 48 (25.4%) versus MwA in 137 (74.6%) patients. Several series have reported that in about one fourth of the cases, an aura precedes the headaches. (11,18,20) The most commonly encountered aura type is visual, followed by sensorial, aphasic, and motor auras, respectively, which are rarely encountered alone but rather accompany visual aura. (11,18,20,21) In our cases, visual auras were the most common, followed (in descending order of frequency) by visual-sensorial (23.5%), pure sensorial, and visual-aphasic auras; motor auras were the least-often encountered (2.9%).
The majority of patients (84.3%) were living in urban areas. The rural-to-urban area ratio was 1:5.3. About half of the cases (48.7%) had a history of education for more than 11 years. Contrary to the old beliefs, recent studies have shown an inverse correlation of migraine prevalence with income. (1,5,6) In their studies, Stewart et al (1) found a strong relation between low income levels and migraine prevalence. They especially have reported a high risk for females 30 to 49 years of age with low income. Outpatient clinic studies conducted in our country have also revealed similar ratios. (14,15) Likewise, in our study, 79.5% had low-medium income levels. In a population-based study, migraine headache rates were reported to be significantly higher in married, educated females living in urban areas. (9) The majority of our patients (70.8%) were married. When the cases were distributed according to their professional status, housewives constituted the highest rate (48.1%); however, this high rate can result from the fact that most females living in our region are house-wives.
Migraine is an inherited inherited
received by inheritance.
inherited achondroplastic dwarfism
see achondroplastic dwarfism.
inherited combined immunodeficiency
see combined immune deficiency syndrome (disease). disease. Migraineurs usually report headaches in their family histories in rates varying from 45% to 70%. (11,22,23) In our study, a family history of headache was found to be at a rate of 72.4%, and the majority of these headaches (56.7%) were defined as migraine.
In the medical histories of our cases, childhood-age vomiting attacks and traveling sickness were reported as a rate of 31.9%. In one study, cyclic cyclic /cyc·lic/ (sik´lik) pertaining to or occurring in a cycle or cycles; applied to chemical compounds containing a ring of atoms in the nucleus.
cy·clic or cy·cli·cal
1. vomiting and traveling sickness is reported to be present in 45% of childhood migraineurs, and is suggested as an additional and reliable minor criterion. (24) Lanzi et al (25) have suggested that the combination of vomiting and traveling sickness is 3 to 6 times more frequently seen in children with migraine than in control subjects.
The basic diagnostic criteria of migraine include headache of throbbing-unilateral character, an attack period lasting 4 to 72 hours, exacerbation ex·ac·er·ba·tion
An increase in the severity of a disease or in any of its signs or symptoms.
ex·ac with routine physical activity, and combination of nausea, photophobia, and phonophobia. (11,14,15,19,20,26-28) Although a unilateral headache is considered specific for migraine, it is a criterion with a low sensitivity. (20) Nausea, photophobia, and phonophobia are more specific features.
A severe functional impairment Impairment
1. A reduction in a company's stated capital.
2. The total capital that is less than the par value of the company's capital stock.
1. This is usually reduced because of poorly estimated losses or gains.
2. defined as needing bed rest was observed in 40.1% of our cases. This rate was 44.1% in cases of MA versus 39% in cases of MwA and 40.8% in females versus 37.5% in males.
Our study reveals that migraine comprises a wide complex of symptoms, causes functional impairment, and is more frequently seen in urban areas, in females, and in subjects with higher education higher education
Study beyond the level of secondary education. Institutions of higher education include not only colleges and universities but also professional schools in such fields as law, theology, medicine, business, music, and art. plus lower income.
Table 1. Mean values of some parameters in the migraine patients Males and females Females Mean age at consultation (yr) 32.4 [+ or -] 10.2 32.9 [+ or -] 10.0 Mean age onset of headache (yr) 22.8 [+ or -] 9.1 22.9 [+ or -] 9.3 Mean duration of migraine history (yr) 9.3 [+ or -] 7.6 9.6 [+ or -] 7.9 Males P value Mean age at consultation (yr) 30.5 [+ or -] 10.5 0.830 Mean age onset of headache (yr) 22.2 [+ or -] 8.7 0.238 Mean duration of migraine history (yr) 8.3 [+ or -] 6.3 0.667 t tests, P [less than or equal to] 0.05; all others nonsignificant. Table 2. Sociodemographic characteristics of migraine cases (a) Males and females Females Frequency % Frequency % Number of cases 185 100 145 78.4 Types MA 48 25.4 39 26.9 MwA 137 74.6 106 73.1 Education None 17 9.2 17 11.7 Graduate school 78 42.2 74 51 Some college 41 22.2 24 16.6 High school or less 49 26.5 30 20.7 Economic level Low 26 14.1 20 13.8 Average 121 65.4 99 68.3 High 38 20.5 26 17.9 Marital status Single 54 29.2 36 24.8 Married 131 70.8 109 75.2 Occupation Housewife 89 48.1 89 61.4 Student 32 17.3 20 13.8 Civil servant 18 9.7 6 4.1 Others 46 24.9 30 20.7 Residence Urban 156 84.3 122 84.1 Rural 29 15.6 23 15.9 Family history of headache Migraine history 76 41.1 53 36.6 Others headache 58 31.3 51 35.2 Patient's life history None 98 53 73 50.3 Allergy 33 17.9 26 17.9 Motion sickness 59 31.9 49 33.8 Males Frequency % Number of cases 40 21.6 Types MA 9 22.5 MwA 31 77.5 Education None ... ... Graduate school 4 10 Some college 42.5 42.5 High school or less 47.5 47.5 Economic level Low 6 15 Average 22 55 High 12 30 Marital status Single 18 45 Married 22 55 Occupation Housewife ... ... Student 12 30 Civil servant 12 30 Others 16 40 Residence Urban 34 85 Rural 6 15 Family history of headache Migraine history 23 57.5 Others headache 7 17.5 Patient's life history None 25 62.5 Allergy 7 17.5 Motion sickness 10 25 Values are frequency and percentages. (a) MwA, migraine without aura; MA, migraine with aura. Table 3. Clinical characteristics of headache attacks (a,b) Males (%) Females (%) MwA MA MwA MA (N = 31) (N = 9) (N = 106) (N = 39) Frequency (per month) [less than or equal to]1 d 19.4 11.2 20.7 19.4 1-3 d 54.8 55.5 57.6 42.1 4-6 d 25.8 33.3 20.8 33.4 [greater than or equal to]6 d ... ... 0.9 5.1 Duration [less than or equal to]4 h 19.5 22.2 10.4 20.5 4-24 h 64.5 55.6 64.2 38.5 24-72 h 9.6 22.2 19.8 30.7 [greater than or equal to]72 h 6.4 ... 5.6 10.3 Intensity Mild ... 11.1 6.6 ... Moderate 16.2 11.1 17 15.4 Severe 80.6 77.8 71.7 82.1 Unbearable 3.2 ... 4.7 2.5 Location Unilateral 74.2 44.4 74.5 69.2 Bilateral 25.8 55.6 25.5 30.8 Quality Pulsatile 80.6 66.7 75.5 84.6 Others 19.4 33.3 24.5 15.4 Aggravation by routine physical activity 61.3 44.4 63.2 69.2 Associated symptoms of headache Nausea 54.8 100 90.6 89.7 Vomiting 29 77.8 52.8 53.8 Photophobia 67.7 88.9 78.3 92.3 Phonophobia 77.4 88.9 76.4 82.1 Males and females (%) MwA MA (N = 137) (N = 48) Frequency (per month) [less than or equal to]1 d 20.4 18.7 1-3 d 56.9 43.8 4-6 d 21.9 33.3 [greater than or equal to]6 d 0.8 4.2 Duration [less than or equal to]4 h 12.4 20.8 4-24 h 64.2 41.6 24-72 h 17.5 29.2 [greater than or equal to]72 h 5.9 8.4 Intensity Mild 5.1 2.1 Moderate 16.8 14.5 Severe 73.7 81.3 Unbearable 4.4 2.1 Location Unilateral 74.5 64.6 Bilateral 25.5 35.4 Quality Pulsatile 76.6 81.3 Others 23.4 18.7 Aggravation by routine physical activity 62.8 64.6 Associated symptoms of headache Nausea 82.5 91.6 Vomiting 47.4 58.3 Photophobia 75.9 91.6 Phonophobia 76.6 83.3 (a) MwA, migraine without aura; MA, migraine with aura. (b) Values are percentages. Table 4. Self-reported precipitating factors for migraine (a) Males and females (%) Females (%) MwA MA MwA MA (N = 137) (N = 48) (N = 106) (N = 39) Stress/tension 71.5 68.1 71.7 71.8 Changes in sleep 48.2 50 44.3 51.3 Noise 43.8 37.5 43.3 38.4 Missing a meal 43.8 35.4 40.6 35.9 Some food or drinks 31.4 37.5 31.1 33.3 Glare 30.7 35.4 28.3 30.8 Menstruation (b) 33 25.7 33 25.6 Strong odors 27.7 20.8 30.2 17.9 Fatigue 26.3 8.3 26.4 10.3 Weather changes 18.2 14.6 19.8 12.8 Males (%) MwA MA (N = 31) (N = 9) Stress/tension 71 55.6 Changes in sleep 61.3 44.4 Noise 45.2 33.3 Missing a meal 54.8 33.3 Some food or drinks 32.3 55.6 Glare 38.7 55.6 Menstruation (b) ... ... Strong odors 19.4 33.3 Fatigue 25.8 ... Weather changes 9.7 22.2 Values are percentages. (a) MwA, migraine without aura; MA, migraine with aura. (b) Women only.
Accepted June 22, 2004.
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1. pertaining to the cranium.
2. toward the head end of the body; a synonym of superior in humans and other bipeds.
adj. neuralgias and facial pain facial pain,
n See pain, facial. . Cephalalgia ceph·al·al·gia
Pain in the head. Also called headache. 1988;8(suppl 7):1-96.
8. Turkish Headache Epidemiological Study An Epidemiological study is a statistical study on human populations, which attempts to link human health effects to a specified cause. Group. Headache Screening Survey. Piar-Gallup, Marketing
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pertaining to or emanating from the nervous system or from neurology.
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n See sensitivity, tooth. : the role of body size. Percept percept /per·cept/ (per´sept?) the object perceived; the mental image of an object in space perceived by the senses.
1. The object of perception.
2. Psychophys 1991;50:175-183.
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18. Ferrari MD. Migraine. Lancet lancet /lan·cet/ (lan´set) a small, pointed, two-edged surgical knife.
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20. Smetana GW. The diagnostic value of historical features in primary headache Primary headache
A headache that is not caused by another disease or medical condition. Tension headaches are a subtype of primary headache.
Mentioned in: Tension Headache syndromes: a comprehensive review. Arch Intern intern /in·tern/ (in´tern) a medical graduate serving in a hospital preparatory to being licensed to practice medicine.
in·tern or in·terne
n. Med 2000;160:2729-2737.
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1. pertaining to or affected with epilepsy.
2. a person affected with epilepsy.
One who has epilepsy. equivalents. Cephalalgia 1983;3:115-118.
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The quality or state of being heterogeneous.
the state of being heterogeneous. : disability, pain intensity, and attack frequency and duration. Neurology 1994;44(suppl 4):S24-S39.
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RELATED ARTICLE: Key Points
* Migraine is one of the most common primary episodic episodic
sporadic; occurring in episodes. e. falling a paroxymal disorder described in Cavalier King Charles spaniels in which affected dogs, starting at an early age, experience episodes of extensor rigidity, possibly brought on by stress. e. headache disorders, characterized by various combinations of neurologic changes.
* A history of migraine is present in perhaps 70% of first-degree relatives.
* About one third of migraineurs were severely disabled and needed bed rest during the attack.
* Migraine is predominately an affliction of young people, particularly females, and has a close association with high education plus low income.
Recep Aygul, MD, Orhan Deniz, MD, Nuri Kocak, MD, Asuman Orhan, MD, and Hizir Ulvi, MD
From the Department of Neurology, Ataturk University Faculty of Medicine, Erzurum, Turkey.
Reprint reprint An individually bound copy of an article in a journal or science communication requests to Dr. Recep Aygul, Ataturk Universitesi, Tip Fakultesi, Noroloji Anabilim Dalt, 25240 Erzurum, Turkey. E-mail: firstname.lastname@example.org