By: Elizabeth Obigwe. Freelance Writer, with medical review and editorial support by the DLHA Team.
Young black girl with chronic daily headache. Image by stefamerpik on Freepik
There are over 200 headache disorders grouped into three major categories namely; primary headaches, secondary headaches, and other headaches.
While secondary headaches are a result of underlying conditions, primary headaches do not have any apparent underlying cause. There are different types of primary headaches and migraine is one of the most common types among patients who seek medical care for headaches.
This article will discuss in detail all you need to know about migraine in Africa including its burden, types, causes, symptoms, diagnosis, treatment and preventive measures.
A migraine is a common headache disorder that causes a throbbing pain on one side (sometimes both sides) of your head, and it is usually associated with other symptoms that affect your eyes and senses.
Migraine is worse than a normal headache and it can get so bad that it prevents you from going about your daily routine. Hence, it is referred to as a disabling condition. It is ranked the seventh-highest leading cause of disability globally.
Of all the types of headaches in Africa, migraine is the most researched. However, the condition is often under-diagnosed and misdiagnosed. Hence, the burden and prevalence may be underreported.
According to a 2017 published study migraine affects 1 in 10 persons globally, with a prevalence of 11.6%. In Africa specifically, the prevalence is lower at 10.4%.
The global statistics also showed a higher prevalence of migraine among females than males, 13.8% and 6.9% respectively. Also, urban residents are reportedly more prone to migraine with a prevalence of 11.2% compared to rural residents with an 8.4% prevalence.
This is similar to statistics in Africa where a community-based studies showed that migraine was more prevalent in females than in males and in urban than in rural areas.
The same study revealed that in 2004, migraine in Africa caused 15% of the continent’s DALYs (Disability Adjusted Life Years) due to neurological disorders. And in 2010, it ranked as the 13th leading cause of YLDs (Years Lived with Disabilities).
Additionally, the study stated that migraine burden is progressively increasing in Africa and the highest rise is projected to happen in the next decade. There is a projection of a 15–29% increase rate of migraine DALYs from 2008–2030 and a 4.87% to 5.20% increase rate in the weight of migraine burden on neurological DALYs.
There are several types of migraine headaches. However, there are two most common types which are differentiated based on whether or not they involve aura.
Aura are reversible changes in the visual, sensory, or other central nervous system events that occur before a migraine headache happens, but can sometimes occur during or after. Examples of these changes include; flickering lights, spots or lines in vision, tingling or numbness in parts of the body, difficulty speaking, etc.
Formerly called classic or complicated migraine, migraine with aura occurs when you experience recurrent attacks of unilateral fully reversible aura symptoms accompanied by migraine headache. The aura symptoms may include one or more of; visual, sensory, speech and/or language, motor, brainstem and retinal.
Each symptom must last between 5 to 60 minutes and be followed by a headache within 60 minutes. If you have more than one aura symptom, they usually follow one another in succession.
Migraine without aura used to be known as common migraine. As the name implies, no aura is associated with this type of migraine. However, you may experience recurrent headaches that last between 4-72 hours. The headache typically occurs on one side of the head and may be moderate or severe with pulsating quality. This migraine can get worse with physical activities and is usually associated with nausea, photophobia (sensitivity to light) or phonophobia (sensitivity to sound).
In children under 18 years, the attack can last up to 2-72 hours and it may be bilateral, that is, occurring on both sides of the head.
Other types of migraines include:
This type of migraine causes fully reversible aura symptoms from the brain stem such as vertigo, ringing/buzzing sound in your ear, decreased level of consciousness, etc. However, there are no retinal or motor symptoms.
Hemiplegic migraine has all the attributes of migraine with aura in addition to a fully reversible motor weakness (weakness of body muscles). The motor symptoms generally last less than 72 hours but, in some patients, motor weakness may persist for weeks.
Hemiplegic migraine is subcategorized into:
FHM is the type of hemiplegic migraine that is genetic. In this case, at least one first-degree or second-degree relative must have had attacks of hemiplegic migraine.
For a person with SHM, no first-degree or second-degree relative has had attacks of hemiplegic migraine.
You may be suffering from retinal migraine if you notice a reversible partial or complete loss of vision. The symptoms may spread gradually and last for 5-60 minutes, followed by a headache within 60 minutes.
Chronic headache typically occurs on 15 or more days/month for more than 3 months. However, on at least 8 days/month, the headache must have the features of a migraine headache.
Although considered as a migraine, this condition may or may not be associated with headaches. It involves recurrent attacks of moderate to severe midline abdominal pain that lasts 2-72 hours. It usually occurs in children under 14 and may be associated with anorexia, nausea, vomiting, and pallor.
There are four stages of migraine as explained below.
1. Prodrome: This is also called the “preheadache” or “premonitory” phase. It can occur one or two days before a migraine. Although it may not happen every time. Symptoms may include sensitivity to light, mood changes, food cravings, neck stiffness, and increased thirst and urination.
2. Aura: Not everyone with migraines experiences this stage. It usually involves visual disturbances, such as seeing various shapes, bright spots, or flashes of light. Some people may also have sensory disturbances or difficulty speaking. Sometimes, this phase occurs together with the headache phase and lasts from 5 to 60 minutes.
3. Headache: This is the most well-known stage of a migraine. It usually involves a throbbing or pulsing pain on one side of the head, sensitivity to light and sound, and sometimes nausea and vomiting. Headaches can last up to 3 days.
4. Postdrome: This stage occurs after the headache has subsided. People may feel exhausted, confused, or moody for up to 24 to 48 hours. Some people call it migraine “hangover.”
Although there are different theories that try to explain the cause of migraine, the main cause of this condition remains unknown. However, doctors suspect that the condition may sometimes be inherited because approximately 70% of patients have a first-degree relative with a history of migraine.
Anyone can come down with a migraine headache. However, there are several factors that can increase your chances of developing it. Some of these factors as stated by Amiri et. al., can either be biological or physiological.
Some general symptoms of migraine headaches in Africa include the following:
Other common accompanying symptoms include:
Your doctor will determine whether or not you have a migraine depending on your complaints and the symptoms you present with. You will be asked questions about your medical history, headache history and pattern, family history etc. Whether or not you have a migraine and the type of migraine you have will be determined according to the International Classification of Headache Disorders (ICHD-3).
Following the history taking and physical examination, your healthcare provider may go ahead to carry out blood and imaging tests such as CT and MRI to rule out other possible causes of headache.
Migraine cannot be cured, but you can treat and manage it. There are two major ways to treat migraine; acute or abortive treatment and prophylactic or preventive treatment.
You can use abortive treatment to stop the progression of a headache that has already started. There are several abortive treatment options used for different purposes. Some of them include:
Preventive migraine treatment reduces the frequency of attacks. It improves responsiveness to the severity and duration of acute attacks, thereby, reducing disability. They include:
Aside from orthodox treatments, Africans also rely on herbal plants to treat certain diseases including migraine. A Nigerian study identified up to 23 medicinal plants with activity against migraine and 29 to have activity against both headache and migraine. Typically, different parts of these plants can be used as medicine — either the roots, leaves, stembark, flowers or oil.
There are a number of other plants that people use to treat migraine in Africa across different parts of the continent. These plants differ depending on the region. However, medicinal plants in Africa are understudied and they are not administered in health centres and hospitals. Hence, people prepare and take them at their discretion or that of a traditional healer.
Other non-drug ways to manage migraine include:
Because the main cause of migraine is unknown, it cannot be completely prevented. However, you can manage it to reduce its frequency of occurrence and the severity of the headache. You can do this using the preventive treatment option discussed earlier and also by avoiding triggers.
It is advisable to see your healthcare provider if;
Migraine is a common type of headache in Africa and its symptoms in the continent are similar to that of other regions around the globe. Still, it is underdiagnosed and often misdiagnosed, so, there is no adequate report on its prevalence and burden in Africa. Like many types of headaches, migraine is still under study and its cause is not yet known, hence, there is no known cure. However, lifestyle changes and medications are effective for managing the condition.
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Headache: An Overview for Africans
Published: January 2, 2024
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