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Epidemiology of tension-type headache (TTH) in Assuit Governorate, Egypt

This is the first study done in our country on a cohort sample sized population to estimate the prevalence of a tension-type headache (TTH) across age groups. This door-to-door study was done in Assiut district, Egypt, throughout one year (2009). This study included a total of 4700 individuals (male: 49.91%; females: 50.09%) with a mean age of was 40.2 ±17.8 years Headache was reported in 35.49% (n=1668), of them 87.65% (n=1462) had primary headache, of them 43.78% (n=640) had TTH with a mean age of 38.5 ±13.5 years and age at onset was 38.5 ±13.5 with a female-to-male ratio was 1.8:1. Nearly 59.22%/32.66% had moderate/mild attacks. Anxiety (27.3%), depression (23.8%) and hypertension (20.5%) were the common comorbid conditions with  TTH. The common reported conditions in the families of individuals with TTH was TTH (27.7%). The frequency of TTH was higher among adults and middle aged individuals, females, singles, rural residents and those with low socioeconomic states.We reported a prevalence of primary headaches to be 31.11%, 13.62% for TTH and 1.57% for mixed  headache. The mean of  headache disability index (HDI) of all individuals with  headache was 48.7 ±8.9. although the emotional disability component of HDI was higher than functional disability component in  TTH, mixed  headache but did not reach statistically significant level. Significant changes were identified between age and a) severity of  TTH particularly after the age of 40 (12.7%) in males (P=0.023) and 20-40 years (16.4%) in females (P=0.0001), b) duration of  TTH particularly after the age of 40 (males: 28.2%; females: 49.6%) (P=0.0001), and c) frequency of TTH attacks (P=0.0001). Also the percentage of chronic/daily TTH was also found to be progressively increased with age particularly after the age of 40 (males: 21.8%; females: 47.2%). The odds ratio of having severe TTH was found to be 5 folds more with co-morbid anxiety (Exp b= 4.964), 2.5 folds more with depression (Exp b=2.562). while prolonged  TTH was found to be 5 folds more in unmarried individuals (Exp b=4.878) and 2 folds more with large number of children (Exp b=1.967). The odds ratio of having chronic  TTH was found to be 11.8 folds more in individuals with severe attacks (Exp b=11.771), 6 folds more in unmarried individuals (Exp b=6.177), 3.3 folds more with prolonged attacks (Exp b=3.341) and 1.2 folds more in each additional age (Exp b=1.176). We believe that the work done in this study is informative as it determined the actual prevalence of TTH across various age groups and the important predictors of changes in its severity, duration and frequency in our locality .





Mahmoud R Kandil, Sherifa A Hamed, Kawthar A Fadel, Ahmad H Youssef, Mohammed A Abd El Hamed, Khaled O Mohamed

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