title: Prevalence of migraine headache and its weight on neurological burden in Africa: a 43-year systematic review and meta-analysis of community-based studies.
abstract: BACKGROUND
  Headache burden is not adequately explored in Africa. Here, we measured weighted migraine prevalence from community-based studies in Africa.
  
  
  METHODS
  PubMed search was employed using terms 'headache in Africa' AND/OR 'migraine in Africa' for published literature from 1970 until January 31, 2014. PRISMA was applied for systematic review. Forest-plot meta-analysis, inter-study heterogeneity, and odds ratio were used to measure weighted prevalence, inter-gender, and urban-rural differences. Disability adjusted life years (DALYs) for migraine and other neurologic disorders in Africa were extracted from Global Burden of Diseases (GBD) 2000-2030.
  
  
  RESULTS
  Among 21 community-based studies included (n=137,277), pooled migraine prevalence was 5.61% (95% CI 4.61, 6.70; random effects) among general population; while 14.89% (14.06, 15.74; fixed effects) among student cohorts. Female students had weighted OR of 2.13 (1.34, 3.37; p=0.0013). Prevalence of migraine was higher among urban population compared to rural settings. Migraine burden is bound to increase by more than 10% DALYs within the next decade.
  
  
  CONCLUSIONS
  Africa has a crude estimate of 56 million people suffering from migraine. By virtue of mainly afflicting the younger working-age group, migraine disability has wider socioeconomic implications. Improving early headache management access points at community-level, training and research at facility-level, and healthy lifestyle modification among urban residents can help reduce this costly and disabling chronic progressive health problem.
authors.affiliation: Stanford Headache Program, Department of Neurology and Neurological Sciences, Room H3160, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5235, USA. Electronic address: yohannes.woldeamanuel@gmail.com.
authors.forename: Yohannes W
authors.initials: YW
authors.lastname: Woldeamanuel
authors.affiliation: Headache Research Laboratory, Section of Anaesthetics, Pain Medicine and Intensive Care, Faculty of Medicine, Chelsea and Westminster Hospital, Imperial College London, 369 Fulham Road, London SW10 9NH, UK.
authors.forename: Anna P
authors.initials: AP
authors.lastname: Andreou
authors.affiliation: Stanford Headache Program, Department of Neurology and Neurological Sciences, Room H3160, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5235, USA.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Cowan
mesh_terms: D000349:Africa / Q000453:epidemiology; D017281:Cost of Illness; D006801:Humans; D008881:Migraine Disorders / Q000453:epidemiology*; D015995:Prevalence; D012424:Rural Population / Q000639:trends; D017678:Sex Distribution; D014505:Urban Population / Q000639:trends
keywords: Burden of Headache in Africa; Community-based studies; Migraine; Neurological disorders; Prevalence; Systematic review and meta-analysis