Migraine in physicians and final year medical students: A cross-sectional insight into prevalence, self-awareness, and knowledge from Pakistan

Table 1 General characteristics and responses of all subjects

Characteristics	Results (N = 175), n (%)
Gender	Females: 88 (50.3)
	Males: 87 (49.7)
Age (yr)	Mean: 25.7 ± 4.1
Grade	Medical student: 39 (22.3)
	House officers: 74 (42.3)
	Non-trainee medical officers: 17 (9.7)
	Trainee medical officer: 38 (21.7)
	Senior registrar: 4 (2.3)
	Assist professor: 2 (1.1)
	Professor: 1 (0.6)
Specialty of doctors	Medicine & allied: 98 (56)
	Surgery & allied: 51 (29.1)
	Others: 9 (5.1)
	Not answered: 17 (9.7)
Do you have migraine?	Yes: 22 (12.6)
	No: 109 (62.3)
	Maybe: 44 (25.1)
Confirmed migraine after reading the ICHD-3 criteria of all 3 types of migraine	Migraine without aura: 36 (20.6)
	Migraine with aura: 9 (5.1)
	Chronic migraine: 3 (1.7)
	No migraine: 127 (72.6)
Consulted any physician	GP: 19 (10.8)
	Medical specialist: 22 (12.6)
	Neurologist: 10 (5.7)
	Ophthalmologist: 19 (10.8)
	Other: 9 (5.1)
	No consultation: 110 (62.8)
Physician able to diagnose migraine	Yes: 45 (25.7)
	No: 9 (5.1)
	Maybe: 9 (5.1)
	Never consulted: 112 (64)
Knowledge of diagnostic criteria of migraine	Heard and remember it: 66 (37.7)
	Heard about it but don't remember: 85 (48.6)
	Never heard about it: 24 (13.7)
Knowledge of prophylaxis of migraine	I know its indications: 59 (33.7)
	I knew its indications but don't remember: 70 (40)
	Know only that it exists: 26 (14.8)
	Don't know about it at all: 20 (11.4)
Aura is essential for migraine?	Yes: 66 (37.7)
	No: 83 (46.8)
	Not sure: 26 (14.7)
Duration of standard prophylactic therapy of migraine?	Do not know: 100 (57.1)
	1 mo: 10 (5.7)
	3 mo: 27 (15.4)
	6 mo1: 24 (13.7)
	12 mo: 14 (8)
Monthly headache rate for prophylaxis	≥ 2 per mo: 64 (36.6)
	≥ 3 per mo: 52 (29.7)
	≥ 4 per mo1: 43 (24.6)
	≥ 5 per mo: 15 (8.6)
	Not available: 1 (0.6)
Used abortive (migraine patients only)	Yes: 12 (25)
	No: 34 (70.8)
	Maybe: 2 (4.2)
Used prophylactic therapy (migraine patients only)	Yes: 9 (18.7)
	No: 38 (79.2)
	Not sure: 1 (2.1)

¹Chosen as the standard in accordance with American Headache Society (AHS) guidelines.

Table 2 Results of analysis between groups based on consult-seeking behaviors and migraine diagnoses

	Consultation seeking			Migraine
	Non-consulters (n = 109)	Consulters (n = 66)	P	Migraineurs (n = 48)	Non-migraineurs (n = 127)	P
Gender	Females: 54 (49.5%); Males: 55 (50.5%)	Females: 34 (51.5%); Males: 32 (48.5%)	0.8	Females: 28 (58.3%); Males: 20 (41.7%)	Females: 60 (47.2%); Males: 67 (52.7%)	0.19
Knowledge of diagnostic criteria	Remember: 37 (33.9%); Don’t remember:72 (66.1%)	Remember: 29 (43.9%); Don’t remember: 37 (56.1%)	0.24	Remember: 25 (52.1%); Don’t remember: 23 (47.9%)	Remember: 41 (32.3%); Don’t remember: 86 (67.7%)	0.016; OR: 2.26 (95% CI: 1.1-4.5)
Know prophylaxis indications	Yes: 31 (28.4%); No:78 (71.6%)	Yes: 38 (34.9%); No: 28 (42.4%)	0.05	Yes: 21 (43.7%); No: 27 (56.2%)	Yes: 38 (29.9%); No: 89 (70.1%)	0.08
Aura essential for diagnosis?	Yes: 65 (59.6%); No or not sure: 44(40.4%)1	Yes: 27 (40.9%); No or not sure: 39 (51.1%)1	0.016; OR: 0.47 (95%CI: 0.25-0.87)	Yes: 22 (45.8%); No or not sure: 26 (54.2%)	Yes: 70 (55.1%); No or not Sure: 57 (44.9%)	0.27
Consulted		Neurologist: 10 (15.2%); Other doctor(s): 56 (84.8%); None: 0 (0%)		Neurologist:8 (16.7%); Other doctors:21 (43.7%); None: 19 (39.6%)	Neurologist: 2 (1.6%); Other doctors: 35 (27.6%); None: 90 (70.9%)	< 0.001
Monthly attack cutoff for prophylaxis2	Correctly Identified: 33 (30.3%); Could not Identify: 75 (68.8%)	Correctly Identified: 10 (15.1%); Could not Identify: 56 (84.9%)	0.02	Correctly Identified: 16; Could not Identify: 32	Correctly Identified: 27 (21.4%); Could not Identify: 99 (78.6%)	0.11
Know correct duration of prophylaxis?3	Yes: 28 (25.7%); No: 81 (74.3%)	Yes :20 (30.3%); No: 46 (69.7%)	0.5	Yes: 13 (27%); No: 35 (73%)	Yes: 35 (27.5%); No: 92 (72.5%)	0.94
Frequency of headache attacks (per month)	None: 31 (28.4%); ≤ 1: 39(35.8%); 2: 17 (15.6%); 3: 6 (5.5%); ≥ 4: 16 (14.7%)	None: 13 (19.7%); ≤ 1: 22 (33.3%); 2: 13 (19.7%); 3: 8 (12.1%); ≥ 4: 10 (15.1%)	0.4	None: 4 (8.3%); ≤ 1: 16 (33.3%); 2: 9 (18.7%); 3: 6 (12.5%); ≥ 4: 13 (27.1%)	None: 40 (31.5%); ≤ 1: 45 (35.4%); 2: 21 (15.7%); 3: 8 (6.3%); ≥ 4: 13 (2.4%)1	< 0.01
Total triggers recognized	Median: 4, IQR: 5	Median: 3, IQR: 4	0.29	Median: 3.5, IQR: 3	Median: 4, IQR: 5	0.297
Total indications recognized	Median: 2, IQR: 1	Median: 1, IQR: 1	0.21	Median: 1, IQR: 1	Median: 1, IQR: 1	0.22
Distractor(s) recognized as triggers	Yes: 47 (43.1%); No: 62 (56.9%)	Yes: 29 (43.9%); No: 37 (56.1%)	0.91	Yes: 22 (45.8%); No: 26 (54.2%)	Yes: 54 (42.5%); No: 73 (57.5%)	0.69
Distractor(s) recognized as Indications	Yes: 37 (33.9%); No: 71 (65.1%)	Yes: 17 (25.7%); No: 49 (74.2%)	0.23	Yes: 16 (33.3%); No: 32 (66.7%)	Yes: 38 (22.1%); No: 88 (87.9%)	0.68
Migraineurs	Migraineurs: 19 (17.4%); Non-migraineurs: 90 (82.5%)1	Migraineurs: 29 (43.9%); Non-migraineurs: 37 (56.1%)1	< 0.001; OR: 3.7 (95%CI: 1.8-7.5)

¹Indicates statistically significant results.

²Monthly headache rate ≥ 4 was chosen as standard for initiation of prophylaxis according to American Headache Society (AHS) guidelines.

³A 6-mo duration of prophylaxis was chosen as standard according to AHS guidelines.

IQR: Inter-quartile range; OR: Odd’s ratio; CI: Confidence interval.

Table 3 Subgroup analysis among migraineurs based on awareness of their disease

	Migraine awareness
	Migraine aware (n = 21)	Not aware (n = 27)	P
Gender	Females: 13 (61.9%); Males: 8 (38.1%)	Females: 15 (55.5%); Males: 12 (45.5%)	0.65
Diagnostic criteria	Remember: 12 (57.1%); don’t remember: 9 (42.9%)	Remember: 13 (48%); don’t remember: 14 (52%)	0.53
Know prophylaxis indications	Know indications: 11 (52.4%); do not know about either prophylaxis or its indications: 10 (47.6%)	Know indications: 10 (37%); do not know about either prophylaxis or its indications: 17 (63%)	0.44
Aura essential for diagnosis?	No: 13 (61.9%); yes or not sure: 8	No: 13 (48.1%); yes or not sure: 14 (51.9%)	0.34
Consulted	Neurologist: 6 (28.6%); Any other physician: 11 (52.4%); Didn't consult: 4 (19%)1	Neurologist: 2 (7.4%); Any other physician: 10 (37%); Didn’t consult: 151 (55.6%)	0.02; OR: 9.6 (95%CI: 1.5-96)
Monthly attack cutoff for prophylaxis	Correctly identified: 5 (23.8%); Couldn't identify: 16 (76.2%)	Correctly identified: 11 (40.7%); Couldn't identify: 16 (59.2%)	0.22
Know duration of prophylaxis	Correctly identified: 6 (28.5%); Couldn't identify:15 (71.4%)	Correctly identified: =7 (33.3%); Couldn’t identify: 20 (66.7%)	0.83
Respondent’s frequency of attacks (per month)	None: 1 (4.8%); ≤ 1: 8 (38.1%); 2: 2 (9.5%); 3: 3 (14.3%); ≥ 4: 7 (33.3%)	None: 3 (11.1%); ≤ 1: 8 (29.6%); 2: 7 (25.9%); 3: 3 (11.1%); ≥ 4: 6 (22.2%)	0.5
Average no of triggers recognized	Median: 3, IQR: 3	Median: 4, IQR: 3	0.32
Average no of indications recognized	Median: 1, IQR: 1	Median: 2, IQR: 1	0.17

¹Indicates statistically significant results.

IQR: Inter-quartile range; OR: Odd’s ratio; CI: Confidence interval.