METABOLOENDOCRINE CROSS SECTIONAL STUDY ON THE RELATION BETWEEN MIGRAINE, HYPOTHYROIDISM AND OBESITY IN NORTHERN AND EASTERN REGION, KINGDOM OF SAUDI ARABIA

Objectives: to determine the relation between Migraine, Hypothyroidism and Obesity in adult to be more aware about the factors which lead to Migraine and how to control them also to collect data for further investigation and suggest methods of control or minimize of its recurrence. Methods: surveillance cross sectional study, data were collected from 15 th of November 2020 till 28 th of February 2021. Study population Male and Females / adults /married or not married/with Obesity or Hypothyroidism or both and suffering from Migraine in Northern and Eastern region, Kingdom of Saudi Arabia, using questionnaires, statistical analysis was done by SPSS 22. Results: 188 responses to the questioner. The study finding showed that the range of participant mostly age between (20-30 y) with (63.3% ) and(41-50y) , (31-40 y) as (16.5%) and (14.4%), As for gender and level of Education the study Conclusion: migraine can be indicator or a sign of other conditions and sometimes patients did not pay attention to them keep taking painkillers without diagnosing the cause . Spreading the awareness among society about factors can cause migraine and medical conditions that also involved in repeating attacks can help in decreasing and controlling attacks of migraine .Health care providers should help in increasing the awareness of healthy life habits and how to control migraine attacks and new methods of treatments.

Can be Classified as: migraine without aura, migraine with aura. Aura refer to something occurs before episode of headache and last from 1 min to 1 hour these include: Speaking impairments, feeling off-balance or dizzy, Visual issues -for example blind spots in vision, or seeing zig-zags and flashing lights, Feelings of numbness and tingling More rarely, loss of consciousness. migraine without aura that occurs without any symptom before episode of headache. Obesity and hypothyroidism are clinical condition that related together. Now, the relation become more relevant which result from rise the prevalence of obesity over wide. Patient generally lock to obesity as secondary to hypothyroidism. Novel view indicates that changes in thyroid-stimulating hormone (TSH) could be secondary to obesity. ( Debmalya and Moutusi. 2016) thyroid hormone and body composition are closely related. Thyroid hormones regulate basal metabolism, food intake and fat oxidation, thermogenesis and play an important role in lipid and glucose metabolism. The aim of this research is to assess the association between obesity, hypothyroidism, and risk of migraine with recommendation of control or minimize of its recurrence.(Peterlin et al 2010).

Material and Methods:-Study Design:
Surveillance cross sectional study.

Study population:
Male and Females / adults /married or not married/with Obesity or Hypothyroidism or both and suffering from Migraine.

Sample collection and strategies:
Data collection was by using standardizing Questionnaires distribution Soft and hard copies of questionnaires distributed to groups of adult's males and females in Northern and Eastern region of KSA and on social media.

Study sampling:
A total of 188 participated in this study.

Statistical Analysis
Data analysis was performed using statistical Package for social Sciences SPSS (version 22) program at significance of > 0.05 and Microsoft Excel-2016 software.

Ethical Consent
Informed Consent was addressed during this study.

Results:-
the study finding shows that the range of participant mostly age between (20-30 y) with (63.3% ) and(41-50y) , (31-40 y) as (16.5%) and (14.4%), As for gender and level of Education the study showed that (80.3%) were female and (19.7%) were male while (63.3%) Bachelor degree and (28.7%) high school as showed in (Table 1). Regarding factors that may lead to inducing attacks of migraine ,the results showed that (48.9%) were over weighted ( 106-120kg) followed by (23.9%) (105-96 kg), for sleeping habits(70.7%) sleeping less than 6 hours /day and (85.1%) using electronic devices on daily bases and (81.4%) were drinking (0.5-1L ) water /day .Over weight ,sleeping deprive and using electronic devices and poor water intake /day helps in inducing migraine attacks. Regarding symptoms accompanied migraine the study found that (51.6 %) of participants suffering from frequent migraine followed by( 23.9%) once per day and (75%) showed that duration of attacks takes 10 hours per day followed by( 13.3%) of the partisans duration takes 12 hours per day which affect the life routine by(58%) and the severity of the headache (60.6%) as mild to(25.6%) moderate level of pain . ( Table 3) Other Hormonal/Metabolic factors that may be related to inducing migraine as hypothyroidism which can lead to gaining weight , the results showed that (9.6%) suffering from hypothyroidism and (92.6%) not diseased but on the other hand (64.4%) don't know that there is a relation between hypothyroidism, gaining weight and migraine and they gain weight lately by (96.3%). (Table 4). For treatment used for migraine attacks the results showed that (62.2%) takes painkillers while (26.1%) depend on home remedy for treatments of migraine , and for the new method of treatment by using BOTOX injection (90.4%) didn't know about this way of treatment. (Table 5).

Discussion:-
Recently , studies showed that there are a relation between migraine and some factors some of this factors related to habits that patients of migraine does without knowing that they can induce migraine attacks, drinking less than 1 liter water per day , sleeping deprive and using electronic devices frequently during the day are some of the major factors, while obesity and hypothyroidism are factors related to disturbance of thyroid hormone which lead to gaining weight bay be without knowing that was the cause of sudden weight gain (Innocenzo et al 2018). As in the presence study results showed that most of the participants were obese also (Pavlovic et al 2017 ) reported that significantly a relation between obesity and migraine as evaluated in clinical-based studies .furthermore (Robberstad et al 2010) mentioned that migraineurs in obese group were nearly twice compared to those in normal weight. For Hypothyroidism and migraine studies showed that association between them with a socioeconomic demographic characteristics ( Moreau et al 1998) who recently study this association in agreement with the results in this study that the endocrine disorder can be one of the important factors that lead to having migraine attacks and with frequently occurring and recurrent . In according with the finding of the present study ( Rainero et al 2015) reported that patients with subclinical hypothyroidism have a significantly increased risk of developing migraine .
Several studies showed there is a complex relationship between migraine ,obesity and hypothyroidism as a metaboloendocrine disease factors among other factors which lead to investigate these relations and try to treat the causative factors in order to decrease the migraine attacks which affects the life routing of patients also migraine can be used as a sign of these disorders or diseases . As the present study showed that most of migraine patients takes painkiller to treat the attacks which will lead to side effects without prescriptions. New method of treatments as using BOTOX to control the attacks but not treat the cause can be used to improve the life routine of frequent migraine patients .
Conclusion:migraine can be indicator or a sign of other conditions and sometimes patients did not pay attention to them keep taking painkillers without diagnosing the cause . Spreading the awareness among society about factors can cause migraine and medical conditions that also involved in repeating attacks can help in decreasing and controlling attacks of migraine .Health care providers should help in increasing the awareness of how to control migraine attacks and new methods of treatments .
Recommendation:more investigations should be done for the relation between migraine and other factors which will help in controlling attacks and help patients to live normal life ,trying new methods of treatments such as Botox will help to manage attacks of migraine till treating the causative factors. Weight loss ,physical activity ,decrease using electronic devices and investigate metabolic and endocrine abnormality in order to diagnose the cause in each case.