This is the first detailed study of the prevalence of headaches in Kuala Lumpur hospital. The results of the study show a higher incidence of migraine headache among the females as compared to males. The gender differences in this present study are consistent with the findings of previous studies. [5, 8, 9] One study reported the peak prevalence of migraine in East Asia was among adult women aged 30 to 49 years, which is in line with worldwide studies on migraine disability. [7, 10] Women with migraine are more likely to experience longer duration of headaches, migraine-associated symptoms, migraine‐related disability and a high burden of comorbidity.  Migraine without aura accounted for the largest proportion of the migraineurs as compared to migraine with aura in the present study. By contrast, a cross sectional study reported a lifetime prevalence of migraine with aura was 5%, with a male to female ratio of 1:2 and lifetime prevalence of migraine without aura was 8%, male to female ratio of 1:7. 
By using ICHD III criteria , we found that the most common symptoms of migraine in our patients was unilateral throbbing headache, nausea and photophobia whereas only approximately half of the patients had vomiting and phonophobia. K. Zarea and colleagues reported the most frequent symptoms of headache are vertigo, photophobia, nausea and vomiting.  An Iranian study revealed that nausea (55.6%), vomiting (40.7%), and photophobia (85.2%) were the common factors for their migraine population, which are similar from the present study. 
Consistent with various research findings, our study showed that among the most frequent trigger factors for migraine headaches are related to stress, weather and sleep deprivation. Other precipitating factors were menstruation, caffein intake, missed meal, postural changes or change in position, prolonged standing, bright lights and change of working environment. J wang and colleagues reported that sleep disturbance (40.1%) was the most common trigger for migraineurs, followed by negative affect (34.2%), sunlight (32.7%) and change of the weather (31.1%) and menstrual cycle (8.8%)  Another recent study conducted in Saudi Arabia revealed that the commonest cause of life style behaviour precipitating migraine was lack of sleep in (88%) cases, followed by stress of exams (67.2%) and prolonged hunger (68.5%). 
In this study, only 4 female patients considered menstrual cycle as a trigger factor for migraine. This is in contrast with a study which showed menstruation had the most significant effect on intensifying migraine headaches (55.6%)  MacGregor and colleagues revealed that migraine frequency will increase following the rapid decline in oestrogen level that normally occurs during the beginning of menstruation.  Fluctuation of oestrogen level could be one of the reasons of the higher incidence of migraine among female. On the contrary, one study reported similar findings when they found a relatively low prevalence rate of 3% migraine with menstrual among 1181 Dutch women.  In addition, they found that migraine associated with menstruation was more severe, persistent and resistant to treatment. 
With regard to treatment for migraine headaches, majority of the patients were not taking any prophylaxis and only two patients received amitriptyline, flunarizine and alprazolam as migraine prophylaxis. One cross-sectional study from a neurology clinic in China revealed 43.1% of patients had not used analgesics, 2.7% had used prophylaxis whereas none had used triptans. [20, 21] During an acute attack of migraine, majority of patients took paracetamol and NSAIDS to relieve headache while only small numbers of patients preferred ergot and triptans as rescue therapy for migraine. This partly could be due to the easy access of paracetamol and NSAIDS and the cost were lower as compared to ergot and triptans.
Most of the migraine sufferers experienced acute attack 4–14 days in a month followed by more than 28 days per month. This study revealed that majority of the patients had higher frequency of migraine most of the days in a month. This could be attributed to the fact that all patients in this study were new cases and mostly were prophylaxis naïve which were mainly referred from primary care clinics with limited resources. They were referred for evaluation and further management as there are wider access of prophylaxis as well as treatment options for migraine headaches in Hospital Kuala Lumpur. As compared to the one study, the frequency of headache was once a month in 43.8% of the patients, once a week in 21.3%, 2–4 times a week in 9.2%, daily in 2.6% and the frequency was variable in 4.6% of patients. 
Few epidemiological studies had investigated whether individuals with migraine are significantly more likely to suffer from a psychiatric disorder such as depression or anxiety than population without migraine headache.  Interestingly, our study only revealed one (2.3%) migraine patient with depression; another (2.3%) patient had anxiety and none of the patients had psychosis. This could possibly due to some patients reluctant to report emotional symptoms. Individuals with migraine headache had been reported 2–5 times more likely to be diagnosed with depression or anxiety disorder. [22, 23] Common genetic factors and pathophysiological abnormalities for instance, serotonergic processing and oestrogen response were playing roles in explaining the association between migraine headache and psychiatric disorders. 
With regard to the education level, majority of our patients with migraine headache pursued tertiary education level followed by patients with secondary level of education. This is also consistent with a study reported that most of the migraine participants (67.6%) had higher education, while the least belong to primary education level (2.8%) and their study showed a positive correlation between migraine and higher educational level as well as satisfactory monthly income. 
Regarding the marital status of migraine patients in this study, most of the patients are single (23, 52.3%) and the remaining was married. (19, 43.2%). Similarly, another study also reported majority of their migraine patients were single (85.2%) as compared to patients who were married (14.8%).  This is in contrast with a study done in Singapore as 59.8% of the migraine patients were married.