The journal of headache and pain, vol.24, no.1, pp.24, 2023 (SCI-Expanded)
Background Headaches are frequent neurological disorders that are yet to be unveiled and treated comprehensively
worldwide. Bearing in mind that the distribution of headache subtypes in neurology clinics (NC) is essential for plan‑
ning appropriate diagnostic and therapeutic approaches, the primary goals of this multi-centric study are to carry out
inter-regional comparisons by using current diagnostic criteria with evaluations of neurologists to delineate headache
burden.
Methods A cross-sectional study between April 1 and May 16, 2022 was conducted with the participation of 13
countries from the Middle East, Asia, and Africa. Patients were included in the study on a specifc day each week dur‑
ing fve consecutive weeks. All volunteers over the age of 18 and whose primary cause for admission was headache
were examined. The patients admitted to NC or referred from emergency services/other services were evaluated by
neurologists by means of the International Classifcation of Headache Disorders (ICHD-3) criteria.
Results Among the 13,794 patients encountered in NC, headache was the primary complaint in 30.04%. The head‑
ache patients’ mean age was 42.85±14.89 (18–95 years), and 74.3% were female. According to the ICHD-3 criteria,
86.7% of the main group had primary headache disorders, 33.5% had secondary headaches, 4% had painful cranial
neuropathies along with other facial and headaches, and 5.2% had headaches included in the appendix part show‑
ing some overlapping conditions. While the most common primary headache was migraine without aura (36.8%),
the most common secondary headache was medication-overuse headache (MOH) (9.8%). Headaches attributed
to COVID-19, its secondary complications, or vaccines continue to occur at rates of 1.2%-3.5% in current neurology
practice. Pain severity was signifcantly lower in Ivory Coast and Sudan than in Türkiye, Turkish Republic of Northern
Cyprus, Iran, Egypt, Senegal, Tatarstan, and Azerbaijan (p<0.001).
Conclusions The study showed that migraine is still the most common motive for admissions to NC in diferent
regions. Furthermore, MOH, an avoidable disorder, is the most common secondary headache type and appears to be
a signifcant problem in all regions. Remarkably, pain perception difers between regions, and pain intensity is lower in
Africa than in other regions.