Abstract
BACKGROUND: Headaches have been consistently associated with mental health disorders. However, current prevalence of headaches in Arab populations is highly varied. Additionally, the potential role of religiosity in this relationship has not been studied. This study aimed to estimate the prevalence of headaches in Saudi Arabia, a highly religious Arab society, to examine their association with mental health disorders, and to explore whether religiosity modifies this relationship. METHODS: This study used the Saudi National Mental Health Survey (SNMHS), a nationally representative, cross-sectional, community-based psychiatric epidemiological household survey. Trained interviewers assessed history of headaches, and common DSM-IV mental health disorders were diagnosed using the Composite International Diagnostic Interview (CIDI). Religiosity was measured using a validated culturally appropriate religiosity scale embedded within the survey. Headache prevalence was calculated as the proportion of respondents reporting headaches relative to the total sample. Survey-weighted logistic regression models were used to estimate adjusted association between headaches and mental health disorders. An interaction term was introduced to explore the role of religiosity. RESULTS: The overall lifetime prevalence of headaches among Saudis was 56% (95% CI: 53%-58%), with 28% reporting recent episode of headaches. In multivariable logistic regression models including sociodemographic factors, respondents with headaches were more likely to have mental health disorders (OR: 2.09, 95% CI: 1.50-2.91; p < 0.001). Religiosity did not modify the association between headaches and mental health disorders (interaction OR: 1.00, 95% CI: 0.98-1.02; p > 0.9). CONCLUSION: Headaches are highly prevalent in Saudi Arabia, with more than half of respondents reporting a lifetime history and nearly one-third experiencing recent episodes. Individuals with headaches are more likely to have mental health disorders. However, varying levels of religiosity do not appear to modify this relationship. These findings underscore the importance of screening for mental health disorders in individuals presenting with headaches, regardless of their religiosity, and highlight the potential value of collaborative models that integrate professional mental health support with religiously sensitive approaches.