Prevalence of Migraine in Medical Students of Dubai Medical College, UAE


 Aim: To assess the prevalence of migraine in students at Dubai Medical College, UAE. Material Methods: A cross-sectional questionnaire-based study was undertaken for three months between December 2020 and February 2021, in Dubai Medical College for Girls, UAE. Results: The students from the first to the final year of MBBS participated in the study. (n=147) Thirty seven percent of the students from this sample size are giving a history of migraine. Family history of migraine is noted in forty five percent of students from this sub-group. The duration of migraine history is between one to five years in nearly sixty two percent of them with a duration of one to five hours and occurring at a frequency of one episode per week in the maximum number of students with a history of migraine. Fifty eight percent of the students experienced an aura preceding the migraine attack, while forty-two percent of the students had no preceding aura. Lack of sleep, examination and physical stress and psychological factors (anxiety, depression, anger) constituted the main triggering factors for the migraine attacks. Conversely, adequate sleep, rest medication (analgesics) and coffee were the salient relieving factors. The students were suffering from mild to moderately severe migraine predominantly, while not many of them had severe migraine. Associated illness in the form of anxiety, allergic rhinitis and polycystic ovarian disease was noted in some of the students with migraine. Medical advice for the migraine was obtained by a very small number of the students. Conclusion: Headache of migraine can have a detrimental effect on a student’s life both personally and professionally. Measures avoiding triggering factors, prophylactic drug treatment and launching of migraine awareness programs at high school levels would all be greatly beneficial in alleviating the student’s headache and halting its progress to a chronic illness; thereby influencing a student’s quality of life remarkably


Introduction
Migraine presents as a pulsatile, throbbing type of headache with poorly understood etiology. It is reported in 10 to 15% of worldwide population has a familial occurrence and is more common in women.
(1) Headache has a tremendous impact on a person's life. The episodic form of migraine if not properly treated can transform to chronic form. (2) Patients with severe migraine report one to ve attacks per month of moderate to severe unilateral pain. It is often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can last for hours to days and the headache signi cantly affects quality of life resulting in considerable health care costs. Migraine almost certainly has a genetic basis, but environmental factors play a signi cant role in its occurrence. Management of headache involves avoidance of triggers of headache (alcohol, chocolate, and stress) and use of abortive treatments as well as prophylactic therapy for acute headache in patients with frequent or severe migraine. (3) Prevalence of migraine in university students has shown to vary from 12.6 to 48%. (4) Students form one of the most common victims of stress in the general population. Stress also depends on the level of education of the students. Medical education involves a college study of not less than ve years. Medical students are exposed to a high level of stress during their medical training and are overloaded with tremendous amount of information. Several studies related to migraine have been performed on medical students as the target population. However, there is a scarcity of the data on headache epidemiology in UAE and the current study was conducted as the rst epidemiological study to evaluate migraine and its associated factors among medical students in Dubai medical students.

Aim
To assess the prevalence of migraine in students at Dubai Medical College, UAE.

Material And Methods
A cross-sectional questionnaire-based study was undertaken for three months between December 2020 and February 2021, in Dubai Medical College for Girls, UAE. The students from the rst to the nal year of MBBS (n=147) participated in the anonymous survey after prior consent and approval from the Research and Ethical Committee at Dubai Medical College. The questionnaire included the demographics, trigger factors, relieving and exacerbating factors, associative illness, family history, duration, and severity of migraine to analyze its prevalence among medical students.

Results
This study includes a sample size of 147 students from rst to the nal year in Dubai Medical College for Girls, UAE. Thirty seven percent of the students from this sample size are giving a history of migraine.
( Family history of migraine is noted in forty ve percent of students from this sub-group. (Table 2) The duration of migraine history is between one to ve years in sixty two percent of them with a duration of one to ve hours and occurring at a frequency of one episode per week in the maximum number of students with a history of migraine. (Table 3)  (2) Fifty eight percent of the students experienced an aura (nausea/vomiting, sensitivity to light and sound, vertigo, ashes of light) preceding the migraine attack, while forty-two percent of the students had no preceding aura. (Table 4)  Table 5 Table 6 The students were suffering from mild to moderately severe migraine predominantly, while not many of them had severe migraine. (Table 7) Associated illness in the form of anxiety, allergic rhinitis and polycystic ovarian disease was noted in some of the students with migraine. (Table 8) Medical advice for the migraine was obtained by an exceedingly small number of students. (Table 9)

Discussion
Our study shows thirty seven percent of medical students studying in Dubai Medical University to be suffering from migraine which is comparable to previous studies showing a prevalence between thirtythree to ninety eight percent in medical students and having a preponderance of female students too. (4-8) The difference might relate to low or no alcohol use in UAE, compared to other countries.
Migraine headaches are of two main types and can occur with or without aura. The headache in both types is similar and women are affected three times more than men. (9) It is noted that majority of the students (75%) had migraine without any preceding aura and only 25% of the migraine cases were accompanied by aura comprising of photophobia, phonophobia and vomiting which is consistent with the previous studies. (10) Vertigo was reported in a small percentage of students as an associated symptom which raises the possibility of vertiginous migraine. (11) Vestibular migraine is the second common cause of vertigo and a common cause of vertigo.
Anxiety was the prominent associated illness followed by allergic rhinitis in the affected students. Anxiety and mood disorders have been shown to be the most relevant psychiatric comorbidities associated with migraine, in uencing its clinical course, treatment response, and clinical outcomes. Previous studies have shown lack of ability to properly control worrying and to relax as the most prominent issues in migraine psychiatric comorbidity. (12) Studies have shown a high prevalence of migraine headaches in patients with allergic rhinitis compared to those without. Histamine and other allergic mediators could play a key role in the pathogenesis of migraine headaches by way of vasodilatation and in ammation. This study has also demonstrated an association between allergic rhinitis and migraine in a small group of the affected students. (13) The duration of history of migraine is reported to be between one to ve years in a predominant number of the subgroup. This indicates that the symptoms of migraine would have started to appear in the students during their high school or immediately after commencement of their medical education as the study sample included medical graduates from the rst to the nal year. This implies the signi cant role of stress responsible for the migraine, as during this phase of their life they worry about meeting academic demands, pleasing parents and teachers, and keeping up with their classmates.
Majority of the students of this study were suffering from mild to moderately severe migraine. Conversely, severe headaches were observed in only a few of the students. Lack of sleep, stress and exams were the major factors responsible for the initiation of migraine attacks. Studies have demonstrated sleep disruption to be a trigger of migraine attacks, which are improved with su cient restful sleep. Typically, people with chronic migraine are prone to morning headaches due to insu cient sleep. (14 -16) Stress due to any cause (emotional/examination) can be a triggering factor for migraine. Stress cannot be avoided during student life; however, it must be kept under control. Measures like proper diet, exercises, time management, positive attitude and taking a break can be very helpful in relieving stress which is also observed in our study.
Family history of migraine is markedly noted in this study. Migraine headaches generally show a multifactorial inheritance pattern, but the speci c nature of the genetic in uence is not yet completely understood. Approximately seventy percent of patients have a rst-degree relative with a history of migraine. The risk of migraine is increased four-fold in relatives of people who have migraine with aura. (17)