Headache is defined as pain of variable intensity and duration, which may be pulsating, burning, pressing, heavy, or otherwise, localized to or radiating across one or several parts or the whole of the cranial vault [2].

Globally, the prevalence of headaches in adults (at least one episode during the past year) is estimated at 58% [3]. Despite regional differences, headaches are a major public health issue worldwide, affecting individuals of all ages, races, income levels, and regions. Headaches are among the most common symptoms encountered in medical practice, with over 90% of individuals reporting a lifetime history, of whom 58.4% have experienced them [3].

According to the Global Burden of Disease study (GBD 2016), tension-type headache and migraine rank as the second and third most prevalent conditions worldwide, just after dental disorders [3]. In sub-Saharan Africa, most studies have been conducted on specific subgroups (hospital populations, children, workers, students, etc.) [4][5]-[7][8][9], reporting widely variable prevalence rates. This disparity prompted recent studies within the framework of the global campaign against headache, using rigorous methodology and International Headache Society (IHS) diagnostic criteria [10].

The first large-scale study in sub-Saharan Africa, conducted in Zambia, reported an annual prevalence of headache of 61.6%, with migraine at 22.9% and tension-type headache at 22.8% [11]. The second, conducted in Ethiopia, found a prevalence of 20.6% for tension-type headache and 17.7% for migraine [12]. These findings confirm that headaches, in Africa as elsewhere, represent a major public health issue with significant negative impact on quality of life and substantial socioeconomic burden [3][13].

In Mali, studies have included a school-based survey showing an overall headache prevalence of 20% and migraine prevalence of 17.3% in a cohort of 4631 students in 2017 [6]. Given the burden of the problem, especially in the active population, our study was undertaken.

To assess the clinical characteristics and quality of life of patients aged 18 - 75 years attending the neurology outpatient clinic at Gabriel Touré University Hospital for headaches.

PatientsandMethods

This was a prospective, cross-sectional study conducted from June to August 2022 at Gabriel Touré University Hospital. It included all neurology outpatients with headaches lasting at least three months, or those already followed for headache, aged 18 - 75 years, and who provided informed consent to participate in the study. We used the diagnostic criteria from the ICHD-3 (2017) to classify the headaches. Patients unable to understand the questionnaire were not included in this study.

Data were collected using a questionnaire including five sections. It includes sociodemographic data (sex, age, occupation, religion, education, marital status, professional experience, residence, and monthly income), clinical features of headache, therapeutic pathways, impact on professional life, quality of life, assessed with the QVLS scale (physical, psychological, functional, and social aspects).

Interviews were conducted individually during outpatient visits, and we performed a descriptive analysis. Migraine was used as a dependent variable (recorded as yes/no) for etiological analysis with independent variables at a significance threshold of α = 0.05. Odds ratios (ORs) were reported with 95% confidence intervals (CI = 95%).

The prevalence of headaches was 6.36% (60/943 patients). Women were predominant (sex ratio 0.62), and housewives represented 25%. In our study population, 43.3% had no income, and 73.3% lived in an urban area. Past cardiovascular medical history was reported in 18%. Family history of headaches was reported by 45% and half (50%) had their first headaches between ages 18 and 36 (Table 1andTable 2).

About 45% had headaches 1 - 5 days/week (2 - 20 days/month), often lasting less than 10 minutes. The majority (73.3%) took medication during headache attacks, and 41.7% used it daily. Paracetamol combined with NSAIDs, or tramadol

Table 1. Sociodemographic and clinical characteristics of participants.

Table 2. Factors associated with migraine.

was the commonly used drug by our patients (35%). Most patients (88.3%) had recurrent headache types, with migraine found in 38.3%. In 61.7% of cases, migraine frequency was 2 - 4 days/week; 63.3% reported episodes lasting less than 10 minutes without treatment. Pain intensity was moderate to severe in 56.7%, with VAS scores between five and eight in 51.3%. Pain was pulsatile in 55% and left-sided in 51.7%.

Physical activity worsened headaches in 53.3%, and 65% reported reduced ability to perform daily tasks. Sensitivity to light or noise was reported by 23.3%. During attacks, 61.7% preferred staying in the dark, and 53.3% remained in silence. Triggers included light (40%); among women, menstruation accounted for 10%.

Half of the patients had consulted a neurologist directly. Amitriptyline was used preventively in 76.7% and most of the patients (56.7%) had never been hospitalized for headaches. Among hospitalized patients (45%), 23.3% stayed fewer than three days, and 70% required sick leave (50% for 1 - 10 days).

Regarding quality of life, 56.7% had mobility problems, 26.7% were bedridden, 51.7% had difficulty with self-care, and 63.3% could not perform routine activities. Severe pain/discomfort was reported by 75%, while 66.7% were extremely anxious or depressed.

Significant associations were found between migraine and sex (p = 0.025), migraine and age (p = 0.025), and migraine and student status (p = 0.005). Migraine was also linked to education level (p = 0.001). Tension-type headache was associated with monthly income (p = 0.001), marital status (p = 0.001), and literacy (p = 0.025). There was no significant association found between chronic headaches and sociodemographic variables (Table 3andTable 4).

Table 3. Factors associated with tension-type headache.

Table 4. Factors associated with chronic headache.

Headaches are common in neurological consultations and have a significant negative impact on patients’ quality of life.

This study was conducted as part of a medical thesis, with approval from the Ethics Committee of the Faculty of Medicine and Dentistry of Mali. In addition, the hospital administration authorization was obtained before the study. Each participant gave free, informed verbal consent. Data were collected anonymously and could not be used to identify patients.

The authors received no financial support for the research, writing, or publication of this article.