Categorization and comparison of patients suffering from migraines without aura or other headaches in primary health care centers in Bosnia and Herzegovina: a cross-sectional, multi-centered, prospective study

Background: Although migraine is among the most common disabling conditions worldwide, it is rarely accurately diagnosed. This study aimed to categorize and compare patients suffering from migraines without aura (MWA) or other types of headaches in primary health care facilities.

Material and methods: We conducted a prospective, cross-sectional, epidemiological, and non-interventional study at 46 primary health care facilities in Bosnia and Herzegovina. The validated Balkan Migraine Screening Questionnaire (BMSQ) was used to classify patients into MWA or non-MWA groups.

Results: The study comprised 1,366 patients categorized into MWA (n =896, 65.6 %) and non-MWA (n =470, 34.4 %) groups. Seven hundred thirty-four patients with MWA were newly identified. The patients in the MWA group were significantly younger, at 49.9 ± 13.7 years, compared to the non-MWA group at 52.0 ± 14.4 years (p =0.008). The MWA group documented less alcohol consumption (11.0 % vs 18.7 % for the non-MWA group, p <0.001) and experienced more severe headaches [headache intensity on Visual Analogue Scale (VAS), with a median score of 7, interquartile range (IQR): 6-8 vs 5 (IQR: 4-7) for the non-MWA group, p <0.001)]. The MWA group had a higher proportion of women (80.1 % vs 64.3 % for the non-MWA group, p <0.001). Compared to the non-MWA group, patients in the MWA group experienced more frequent headache attacks (more than six attacks in the preceding six months: 50.6 % vs 28.1 %, p <0.001), needed additional headache treatment (using two or more classes of antiheadache therapy 41.3 % vs 26.4 %, p <0.001), and had a positive family history of migraine (46.9 % vs 23.0 %, p <0.001). The binomial regression model identified two positive predictors (family history of migraines and headache intensity) and one negative predictor (alcohol consumption) for the BMSQ classification of patients into the MWA group.

Conclusion: More than half the patients in this study were newly classified as having MWA, indicating a high prevalence of undiagnosed migraine. Categorization of patients with headaches is of crucial importance for appropriate treatment and should be utilized in everyday practice in primary health care settings. HIPPOKRATIA 2023, 27 (2):99-105.