title: Prevalence of primary headaches in an urban slum in Enugu South East Nigeria: a door-to-door survey.
abstract: OBJECTIVE
  This study aims to determine the prevalence of primary headache disorders using the second edition of international classification of headache disorders among urban slum dwellers. Headache is a common neurological disorder and one of the most common reasons for visiting the neurology clinics in Nigeria. Low socioeconomic status has been linked with primary headaches. Factors that may precipitate and sustain headaches are common in Africa especially in urban slums. There are limited population based data on the prevalence of headache from Nigeria and other African countries.
  
  
  METHODS
  A 3 phase cross-sectional descriptive study was done to survey at least 40% of the adult population (Igbos) living in an urban slum using the International Classification of Headache Disorders 2nd Edition (ICHD-I) criteria using a validated Igbo language adaptation (translation and back-translation into Igbo language) of a World Health Organization protocol for screening neurological disorders in the community.
  
  
  RESULTS
  The lifetime prevalence of headache of any type was 66.7% (95% confidence interval [CI] 64.2-69.2), significantly higher in females (70.2% [95% CI 67.0-73.4]) than in males (62.3% [95% CI 58.5-66.1]; P = .0.002). The prevalence of primary headaches was also significantly lower in males than in females (44.9% [95% CI 45.5-53.3] vs 53.2% (95% CI 49.3-57.1), P = .002). Female (52.1%) drinkers had a statistically higher prevalence of primary headaches than male drinkers (43.6%; P = .004). The prevalence of migraine was 6.4% (95% CI 5.1-7.7); 7.5% (95% CI 5.6-9.4) in females and 5% (95% CI 3.3-6.7) in males (P = .058). Migraine with aura was similar in both males and females. Migraine without aura was significantly higher in females (5.7%) than males (3.1%) (P = .022). Tension-type headache (TTH) had an overall prevalence of 13.8% (95% CI 11.3-16.3), males 12.2% (95% CI 9.7-14.7), and females 15.1% (95% CI 12.6-17.6; P = .118.) The peak decade for all primary headaches was 20-29 years for males (49.8%) and 60-69 years for females (57.5%).
  
  
  CONCLUSIONS
  Headache is a common health problem in an urban slum in Enugu south east Nigeria where 66.7% of participants had experienced headache in their lifetime, and 49.4% had experienced primary headaches. The prevalence of migraine and TTH were 6.4% (5% in males and 7.5% in females) and 13.8% (12.2% in males and 15.1% in females), respectively. The peak ages of migraine and tension-type headache were 30-39 and 60-69 years, respectively. The prevalence of primary headaches was significantly higher among subjects who used alcohol significantly.
authors.affiliation: Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria.
authors.forename: Birinus A
authors.initials: BA
authors.lastname: Ezeala-Adikaibe
authors.forename: Chinwe
authors.initials: C
authors.lastname: Onyekonwu
authors.forename: Grace
authors.initials: G
authors.lastname: Okudo
authors.forename: Obinna
authors.initials: O
authors.lastname: Onodugo
authors.forename: Stella
authors.initials: S
authors.lastname: Ekenze
authors.forename: Casmir
authors.initials: C
authors.lastname: Orjioke
authors.forename: Peter
authors.initials: P
authors.lastname: Chime
authors.forename: Obum
authors.initials: O
authors.lastname: Ezeanosike
authors.forename: Nkiru
authors.initials: N
authors.lastname: Mbadiwe
authors.forename: Mark
authors.initials: M
authors.lastname: Chikani
authors.forename: Celestine
authors.initials: C
authors.lastname: Okwara
authors.forename: Ifeoma
authors.initials: I
authors.lastname: Ulasi
authors.forename: Uchenna
authors.initials: U
authors.lastname: Ijoma
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006261:Headache / Q000145:classification / Q000453:epidemiology*; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D011204:Poverty Areas; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Nigeria; migraine; primary headache; tension type headache; urban slum