BD is a multi-organ disease, it affects younger population especially patients in their second to fourth decades, but it can present at any age (7). This confirms with our results; the total mean is 33.84 (± 3.31). The dominant gender in our study is male which also confirms with the fact that men are dominant among BD patients in the Arab population (5).
The frequent early manifestations of neurological involvement in BD are headache, fever, disorientation, poor balance or stroke, pyramidal signs, behavioural changes, and sphincter disturbance (4, 18, 19). However, headaches in BD patients might be an indication for the neurological involvement of BD, but most of those headaches are benign (14). Sometime BD could be misdiagnosed as aseptic meningitis, multiple sclerosis or primary neoplasm (14). On the other hands, some studies indicated that although headache is so high among BD patients, they do not consider this as a neurological involvement sign but only a major complaint of many patients (12, 15).
We found a higher prevalence of headaches in BD patients like Borhani,et al (10) Volpinari S,et al (16)and Kale et al (17). study, but less than the percentage found in some other studies, like Kidd et al (18), Monastero et al (19), and Turkish Headache Epidemiology Study Group (20) Saip et al (21). These differences may be due to the ethnicity variables, and the geographic distributions especially the Turkish study.
Tension-type headaches, uveitis-related headaches were more frequent among patients with BD than the control group, according to a study of Vinokur M,et al (22),and this was similar to our findings.
However, uveitis had a significantly positive correlation with the frequency of headaches in BD patients (18, 19). It differs from another study (17) which found that the most extra parenchymal involvement were venous thrombosis, seizure disorder, and psychiatric problems/depression or anxiety. Also, Vinokur M,et al (22), in their results, found that the most common cause of secondary headache was venous thrombosis
The frequency of non-structural headaches was one-third of that reported in the study carried out in Turkey (20) and we have only recorded 2 patients suffering from this type of headache in our study and maybe the larger sample size of the Turkish study had played a role.
Some opinions suggest that steroids may use in a dose more than 30 mg/day for 15 days in the treatment of BD- related headache (23, 24). The prevalence of headaches was not significantly different between prednisolone received patients and those who did not consume prednisolone. Otherwise, it is well known that headache is a less common side effect of cyclophosphamide treatment, which may be due to the elevation of blood pressure which could happen during the infusion of cyclophosphamide. No data were found about the prevalence of headaches during cyclophosphamide infusion (25, 26).
The rate of using the treatment for headaches in our study was higher in both groups compared to the previous studies (24, 25, 27). The facility of buying analgesics in Syria may explain these differences. Moreover, in our study, the presence of a family history of headaches was not significantly different between both groups, which is in concordance with some studies (27, 28).
Even if it is the first research that studies the headaches symptoms among Syrian Behcet disease patients, but it is major limitation is the small patients sample size and the enrolment of the study in one referral centre. The rarity of the disease and its underdiagnosis in Syria as well as the specific geographical distribution may be the factors that induced a small sample size and were obstacles in the study. But our findings indicated that headache in Syrian BD patients was not significantly different from the healthy population. This means that headache treatment among BD patients. Should not differ from the normal guidelines of the general population. However, further research with a higher sample size or multicentral research is highly recommended for a better understanding of neurological symptoms especially headaches among Mediterranean or Syrian BD patients.