Journal of Transcultural Nursing

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Prevalence of Migraine Headaches in the Romany Population in Spain: Sociodemographic Factors,

Lifestyle and Co-Morbidity
Silvia Jimnez-Snchez, Csar Fernndez-de-las-Peas, Rodrigo Jimnez-Garca, Valentn Hernndez-Barrera, Cristina
Alonso-Blanco, Domingo Palacios-Cea and Pilar Carrasco-Garrido
J Transcult Nurs 2013 24: 6 originally published online 16 July 2012
DOI: 10.1177/1043659612452008
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2008

rsing XX(X)

TCNXXX10.1177/1043659612452

Research Department

Prevalence of Migraine Headaches

in the Romany Population in Spain:
Sociodemographic Factors, Lifestyle
and Co-Morbidity

Journal of Transcultural Nursing

24(1) 613
The Author(s) 2013
Reprints and permission:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/1043659612452008
http://tcn.sagepub.com

Silvia Jimnez-Snchez, MSc, PT1, Csar Fernndez-de-las-Peas, PhD, PT1,

Rodrigo Jimnez-Garca, PhD1, Valentn Hernndez-Barrera, MD1,
Cristina Alonso-Blanco, PhD1, Domingo Palacios-Cea, PhD1,
and Pilar Carrasco-Garrido, PhD1

Abstract
Purpose: To compare the prevalence of migraine headaches in the Romany population with the prevalence in the general
Spanish population and to describe its association with demographic and clinical risk factors. Method: A cross-sectional
study using data from the 2006 Spanish National Health Survey (n = 16,079) and the National Health Survey in the Romany
Population (n = 993). Inclusion criteria were migraine headache diagnosed by a neurologist, suffered over the preceding
2 weeks that reduced work or leisure activity by half a day or more. Results: The prevalence of migraine in the Romany
population (29.4%, 95% confidence interval [CI] = 26.48-32.53) was significantly higher than in the general Spanish population
(12.52%, 95% CI = 11.85-13.22). Females (odds ratio [OR] = 1.56, 95% CI = 1.10-2.21), those 40 years old (OR = 4.17, 95%
CI = 1.78-9.62), those sleeping 8 hours/day or less (OR = 1.85, 95% CI = 1.32-2.59), those with body mass index >30 kg/m2
(OR = 1.75, 95% CI = 1.15-2.65), those suffering from osteoarthritis (OR = 2.59, 95% CI = 1.54-4.36), and those suffering
from allergy (OR = 1.69, CI = 1.05-2.71) were associated with higher incidence of migraines. Romanies with migraines
reported worse self-perceived health status (OR = 2.11, 95% CI = 1.41-3.15) and higher incidence of depression (OR = 2.09 95%
CI = 1.32-3.30) than those without. Discussion: Prevalence of migraines is greater in the Romany living in Spain than in the
general Spanish population. Implication for practice: Public health systems should focus prevention campaigns specifically
on this population and concentrate on those factors that are potentially modifiable.
Keywords
migraine, headache, Romany population, risk factors, comorbidity, population-based, community health, transcultural health

The Romani, also known as Romany, Romanies, Romanis,

Roma, or Roms, are an ethnic group currently living mostly
in Europe but tracing their origins to the Indian subcontinent.
Romani are also widely known in the English-speaking
world as gypsies. Both the terms, Rom and Romani, have
been in use in English since the 19th century as an alternative
for gypsy. Romani are widely dispersed, with their largest
concentrated populations in Europe, especially the Roma of
Central and Eastern Europe and Anatolia, followed by the
Kale of Iberia and Southern France. Although Roma is used
as a designation for the branch of the Romani people with
historic concentrations in Eastern Europe and the Balkans, it
is increasingly encountered during recent decades as a
generic term for the Romani people as a whole (McDowell,
1970). The Romanies are generally identified by their dark
skin and hair, the Romani language they speak, their seasonal work, and fortune-telling.

To date, there is no official census of the Romany population residing in Spain (Europe). It is estimated that Spain has
970,000 Romany people, which constitutes about 2% of the
entire population (Fundacin Secretariado Gitano, 2009).
Despite their centuries-long presence in Spain, little information is available regarding the health status of this population. Numerous studies have reported that this population
has certain social, economic and health inequalities in comparison with general Spanish population (Ferrer, 2003;
Garca-Campayo & Alda, 2007; Hajioff & McKee, 2000;
1

Universidad Rey Juan Carlos, Madrid, Spain

Corresponding Author:
Csar Fernndez-de-las-Peas, Facultad de Ciencias de la Salud,
Universidad Rey Juan Carlos, Avenida de Atenas s/n, 28922 Alcorcn,
Madrid, Spain
Email: cesar.fernandez@urjc.es

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Jimnez-Snchez et al.
Iraurgi, Jimnez-Lerma, Landabaso, Arrazola, & GutirrezFraile, 2000; Ksa et al., 2007; Palanca, 2002; Vok et al.,
2009; Zajc et al., 2006; Zeman, Depken, & Senchina, 2003)
Data about pain, and headache, and its functional limitation are relatively scarce in the Romany population (Hajioff
& McKee, 2000). Different population studies have shown
that headache is probably the most prevalent neurological
disorder seen by medical doctors and usually experienced by
almost everyone (Bendtsen & Jensen, 2009). Headaches
cause substantial disability for patients, their families, and the
global society because of their very high prevalence in the
general population (Stovner et al., 2007). In Spain, a recent
population-based study showed that the 1-year prevalence of
diagnosed migraine headaches was 11.02% in the general
population (Fernndez-de-Las-Peas et al., 2010). No study
has investigated the prevalence of diagnosed migraine headaches in the Romany population (Hajioff & McKee, 2000).
The aims of the current study were (a) to estimate the
prevalence of migraine in the Romany population and its
relation to sociodemographic characteristics, lifestyle habits,
self-reported health status, and presence of other diseases;
(b) to compare differences in the prevalence of migraine
headaches between the Romany and the general population
in Spain; and (c) to identify factors associated with migraine
in the Romany population.

Method
A population-based cross-sectional study was conducted
using data from two different national surveys that were
comparable in designs and conducted in 2006. The first
was the 2006 Spanish National Health Survey (SNHS) that
surveyed the general population residing in Spain; the second was the 2006 National Health Survey in the Romany
Population (NHSRP), which specifically targeted the
Spanish Romany population.

The 2006 Spanish National Health Survey

The SNHS is an ongoing, home-based personal interview
examining a nation-wide representative sample of civilian noninstitutionalized population residing in main family dwellings
(households) in Spain. The SNHS is primarily conducted by the
National Statistics Institute (Instituto Nacional de Estadstica)
under the auspices of the Spanish Ministry of Health and
Consumer Affairs (Instituto Nacional de Estadstica, 2006;
Ministerio de Sanidad y Consumo, 2006). Participants were
selected by means of probabilistic multistage sampling (randomized), with the first-stage units being census sections and
the second-stage units being main family dwellings. For the
current study, adults were selected from the first two stages
conducted in 2006 (n = 16,079). More detailed description of
the SNHS methodology can be found within the Ministerio de
Sanidad y Consumo (2006). Surveyors had undergone training
in basic communication skills, procedures, and the questionnaire. Information was collected by home-based personal

interviews. The format of this survey was adapted to meet the

requirements of the European project for performance of health
surveys (European Commission, 2010).

The 2006 National Health

Survey in the Romany Population
In 2006, the Spanish Ministry of Health and Consumer
Affairs and the Spanish organization Fundacin Secretariado
Gitano decided to conduct the first Health Survey on the
Romany Population in Spain. The sample was composed of
1,500 people aged from 16 to 80 years of both genders, who
were noninstitutionalized, of Spanish nationality, and
belonging to the Romany population. Data were collected by
means of individual interviews. The NHSRP was designed
following the same methodology as the SNHS (Ministerio
de Sanidad y Consumo, 2010).

Epidemiological Variables
The questions that were included in the 2006 NHSRP were
the same as those that had been used in the 2006 SNHS,
allowing, for the first time, a direct comparison of the health
status of the Romany population with that of the general
population in Spain. For this study, data from a total of 993
Romanies and from 16,079 individuals from the general
Spanish population, aged 16 years or older were included.
The variables included in this study were created on the
basis of a series of questions included in the main questionnaires. Subjects were considered as migraine sufferers if
they responded yes to all three of the following questions
included in both surveys: (a) Have you suffered migraine
over the previous 12 months? (b) Has your neurologist confirmed the diagnosis of migraine? and (c) Have you had to
reduce your working activity or recreational activities in
your free time for at least half a day during the past 2 weeks
as a consequence of migraine?
We analyzed sociodemographic characteristics (i.e., gender, age, marital status, educational level, occupational status,
and rural/urban area), self-perceived health status over the
previous 12 months (dichotomized into excellent/good or
fair/poor/very poor), lifestyle-related habits (smoking and
sleep habits, alcohol consumption, obesity [body mass index
30 kg/m2] and physical exercise, walking or participating in
sports), and presence of diagnosed concomitant diseases,
including hypertension, asthma, heart disease, arthritis,
allergy, diabetes, hypercholesterolemia, osteoporosis, or
menopausal symptoms, and depression as independent variables. For the presence of concomitant diseases, individuals
should have answered yes to the following question: Has the
doctor told you that you suffer from any of these diseases?

Statistical Analysis
The prevalence of principal variables was calculated in the two
target populations. Bivariate logistic regression models were

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Journal of T ranscultural Nursing 24(1)

Table 1. Prevalence of Migraine Headaches, Demographic Characteristics, and Self-Perceived Health Status in Study Sample of Romany
and General Populations in SPAIN

Variable
Diagnosis of migraine headache
Gender
Age (years)

Residential area
Education: number of years
completed
Occupational status
Self-perceived health status

Category
Male
Female
16-39
40-64
65
Urban
Rural
No formal education
Primary (14 years completed)
More than primary (>14 years)
Unemployed
Employed
Excellent or good
Fair, poor, or very poor

General Spanish population

(n = 16,079), % [95% CI]

Romany population
(n = 993), %
[95% CI]

12.52 [11.85, 13.22]

49.13 [48.04, 50.23]
50.87 [49.77, 51.96]
42.82 [41.71, 43.94]
38.68 [37.64, 39.73]
18.50 [17.77, 19.24]
78.12 [77.24, 78.97]
21.88 [21.03, 22.76]
11.60 [10.96, 12.28]
30.69 [29.72, 31.67]
57.71 [56.64, 58.77]
48.13 [47.04, 49.22]
51.87 [50.78, 52.96]
65.97 [64.96, 66.97]
34.03 [33.03, 35.18]

29.42 [26.48, 32.53]

46.94 [43.64, 50.27]
53.06 [49.73, 56.36]
64.52 [61.26, 67.65]*
28.21 [25.29, 31.32]
7.27 [5.73, 9.18]
90.28 [88.02, 92.14]*
9.72 [7.86, 11.98]
65.75 [62.43, 68.92]*
27.82 [24.87, 30.97]
6.43 [4.87, 8.45]
51.72 [48.39, 55.03]*
48.28 [44.97, 51.61]
64.82 [61.60, 67.92]
35.18 [32.08, 38.40]

Note. 95% CI = 95% confidence interval.

*Statistically significant differences between general and Romany populations (p < .01).

used to estimate a measure of association. A multivariate analysis was carried out using those variables statistically significant
in the bivariate analysis and those that were of interest from an
epidemiological viewpoint. Using the Wald statistic, variables
were eliminated, based on their significance to the model used
and considering the models goodness of fit with regard to the
previous step (likelihood ratio test). The effects of interaction
among the variables included in the final model were also
examined. Estimates were made by incorporating the sampling
weights, using the svy (survey command) functions of the
STATA program, which enabled us to incorporate the sampling design into all statistical calculations. Statistical significance was set at two-tailed < .05.

Results
The prevalence of migraine headaches in the Romany
population was 29.42% (95% confidence interval
[CI] = 26.48-32.53), which was significantly higher (p < .001)
than in the general Spanish population (12.52%, 95%
CI = 11.85-13.22; see Table 1).

Characteristics of Romany Population

Compared with the Spanish sample, the Romanies were
younger (65% were 16-39 years old), lived primarily in urban
areas, and less educated (65.75% did not complete primary
education), and 50% were unemployed (see Table 1).
The Romanies drank and smoked more, had fewer exsmokers, slept more than 8 hours/day; performed less
physical activity; and had a greater proportion of individuals

with obesity compared with the general population (p < .001;

see Table 2). In addition, Romanies reported significantly
less (p < .001) hypertension, hypercholesterolemia, heart
disease, stomach ulcers, and arthritis.

Characteristics of Individuals
Suffering From Migraine Headaches
Bivariate analysis revealed significantly higher prevalence
of migraines in females than males, particularly among
those between 40 and 64 years old (p <0.001). Individuals
with migraines were mostly without primary education and
unemployed (p < .001). Individuals with fair, poor, or very
poor health status reported sleeping less than 8 hours per
day, and those with a body mass index >30 kg/m2 showed
greater prevalence of migraines. Although the prevalence of
migraines was associated with several chronic diseases in
both groups, Romanies had twice the rate of comorbidity as
the general population (p < .05; see Table 3).

Variables Significantly Associated With

Migraine Among the Romany Population
Multivariate logistical regression analyses revealed that
Romany women had 1.56 (95% CI = 1.10-2.21) times
greater probability of suffering from migraines than men.
Being younger than 40 years (odds ratio [OR] = 4.17, CI =
1.78-9.62), being unemployed (OR = 1.51, CI = 1.06-2.14),
sleeping less than 8 hours/day (OR = 1.85, CI = 1.32-2.59),
and being obese (OR = 1.75, CI = 1.15-2.65) were associated with migraines among the Romany population. Fair,

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Jimnez-Snchez et al.
Table 2. Lifestyle Characteristics and Co-morbid Conditions in Study Sample of Romany and General Populations in Spain
Variable
Smoking habit

Alcohol consumption
Sleep habits

Category
Smoker
Ex-smoker
Nonsmoker
8 hours/day
<8 hours/day

Physical exercise
Obesity (BMI >30 kg/m2)
Hypertension
Asthma
Heart disease
Osteoarthritis
Allergy
Diabetes
Stomach ulcer
Hypercholesterolemia
Depression
Osteoporosis
Prostate problems
Menopausal symptoms

General population
(n = 16.079), % (95% CI)

Romany population
(n = 993), % (95% CI)

30.16 [29.14, 31.20]

20.63 [19.76, 21.49]
49.21 [48.12, 50.30]
13.14 [12.42, 13.90]
48.44 [47.34, 49.54]
51.56 [50.46, 52.66]
57.62 [56.53, 58.70]
14.64 [13.87, 15.45]
20.16 [19.36, 20.99]*
8.73 [8.15, 9.35]
7.21 [6.72, 7.73]*
20.56 [19.77, 21.38]*
12.41 [11.70, 13.15]
5.98 [5.51, 6.47]
6.10 [5.62, 6.62]
15.64 [14.93, 16.39]*
14.25 [13.56, 14.96]
4.83 [4.46, 5.24]
6.80 [6.12, 7.55]
7.08 [6.44, 7.77]

40.07 [36.84, 43.38]*

11.91 [9.92, 14.25]
48.02 [44.71, 51.34]
55.40 [52.09, 58.66]*
57.89 [54.58, 61.14]*
42.11 [38.86, 45.42]
35.69 [32.56, 38.94]*
21.17 [18.53, 24.08]*
15.07 [12.86, 17.59]
8.60 [6.96, 10.59]
4.71 [3.48, 6.34]
15.29 [13.03, 17.87]
14.77 [12.49, 17.38]
5.61 [4.33, 7.24]
8.54 [6.85, 10.61]*
12.61 [10.59, 14.95]
16.03 [13.75, 18.61]
4.33 [3.12, 5.99]
4.20 [2.57, 6.82]
7.74 [5.65, 10.50]

Note. 95% CI = 95% confidence interval; BMI = body mass index.

*Statistically significant differences between general and Romany populations (p < .001).

poor, or very poor health status was related to the prevalence

of migraines (OR = 2.11, CI = 1.41-3.15). Among the
comorbid diseases, arthritis (OR = 2.59, CI = 1.54-4.36) and
allergy (OR =1.69, CI = 1.05-2.71) had the highest adjusted
OR. Depression showed an OR of 2.09 (95% CI = 1.32-3.30).
Table 4 summarizes the results of the multivariate analysis
with the adjusted OR of variables associated with a higher
likelihood of suffering from migraine in the Romany
population.

Discussion
This is the first Spanish study comparing data on migraine
headaches from two national health surveys, on the Romany
population and the general Spanish population. The results
indicate that the prevalence of migraine in the Romany
population was twice (29.42%) that of the general Spanish
population (12.52%). Female gender, age <40 years, unemployed, poor self-perceived health status, sleeping less than
8 hours per day, and obesity, arthritis, allergies, and depression were positively associated with migraines in the
Romany population.

Comorbidity of Chronic
Diseases in the Romany Population
The study findings revealed that the Romanies suffered from
fewer number of comorbid diseases. This is in contrast to

previous studies, which reported the opposite, and suggested

that unhealthy eating, drinking, smoking, and performing
less physical activity could be the main reasons for suffering
from a greater number of comorbid diseases (GarcaCampayo & Alda, 2007; Thomas, 1985; Thomas, Doucette,
Thomas, & Stoeckle, 1987). Although the study found
unhealthy lifestyles in the Romany population, they reported
fewer comorbid diseases. One possible reason for this difference is that in the current study, comorbid diseases had to be
diagnosed by a medical doctor, and Romanies are generally
more reluctant to go to health centers (Ksa et al., 2007).
Only the presence of symptoms, such as a migraine headache, prompts them to seek health care. When Romanies
seek medical care, they often come in conflict with medical
personnel who find their behavior confusing, demanding,
and chaotic (Sutherland, 1992). Romanies may also suffer
from discrimination or exclusion from health services,
depending on their region of residence (Corretger, Fortuny,
Botet, & Valls, 1992; Ksa et al., 2007). Discrimination of
ethnic and racial minorities and of those with lower socioeconomic and political power has been reported to influence
access and utilization of health services (Ariza-Montoya &
Hernndez-lvarez, 2008). People living in Roma settlements experience social exclusion, which affects their health
status (Hajioff & McKee, 2000; Ksa et al., 2007).
Obesity affected 21.17% of the Romanies, with higher
percentages among those with migraines (45.19%). In contrast, there was lower prevalence of obesity (14.64%) and

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10

Journal of T ranscultural Nursing 24(1)

Table 3. Distribution According to Sociodemographic characteristics, Self-Perceived Health Status Lifestyle Variables, and Comorbidity
of Romany Population and General Population With Migraine Headaches
Variable

Category

General population
(n = 16.079) % (95% CI)

Romany population
(n = 993) % (95% CI)

Gender

Male
Female
16-39
40-64
65
No studies
Primary
More than primary
Unemployed
Employed
Excellent/good
Fair/poor/very poor
Smoker
Ex-smoker
Nonsmoker
No
Yes
8 hours/day
<8 hours/day
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes

7.09 [6.26, 8.02]

17.76 [16.75, 18.81]*
10.40 [9.37, 11.52]
14.72 [13.62, 15.89]*
12.81 [11.51, 14.24]
18.42 [16.12, 20.96]*
13.45 [12.27, 14.73]
10.76 [9.93, 11.65]
14.14 [13.17, 15.18]*
11.01 [10.10, 11.98]
7.96 [7.29, 8.69]
21.35 [19.95, 22.81]*
12.26 [11.01, 13.61]
10.64 [9.36, 12.07]
13.46 [12.50, 14.49]*
12.05 [11.34, 12.79]
15.59 [13.63, 17.78]*
10.92 [9.97, 11.94]
14.06 [13.12, 15.05]*
13.01 [11.97, 14.12]
12.15 [11.29, 13.07]
12.08 [11.32, 12.87]
14.29 [12.43, 16.37]*
11.22 [10.50, 11.99]
17.64 [16.04, 19.36]*
11.67 [10.99, 12.38]
21.37 [18.64, 24.37]*
12.01 [11.32, 12.73]
19.07 [16.49, 21.95]*
10.00 [9.30, 10.74]
22.24 [20.52, 24.05]*
11.53 [10.85, 12.24]
19.48 [17.13, 22.07]*
12.42 [11.73, 13.15]
14.02 [11.58, 16.89]
11.96 [11.27, 12.67]
21.12 [18.10, 24.50]*
11.41 [10.70, 12.17]
18.47 [16.68, 20.40]*
9.70 [9.04, 10.39]
29.49 [27.18, 31.91]*
11.73 [11.06, 12.45]
27.90 [24.47, 31.60]*
6.57 [5.72, 7.52]
14.25 [10.87, 18.45]*
16.63 [15.61, 17.70]
32.51 [28.18, 37.17]*

20.72 [17.02, 24.98]

37.11 [32.83, 41.61]
25.58 [22.15, 29.33]
38.08 [32.15, 44.40]
29.84 [19.89, 42.15]
34.31 [30.50, 38.32]
21.18 [16.31, 27.02]
21.58 [11.79, 36.17]
34.27 [30.02, 38.79]
24.22 [20.36, 28.54]
19.82 [16.68, 23.37]
47.37 [41.89, 52.92]
26.09 [21.67, 31.06]
24.04 [16.86, 33.04]
33.52 [29.20, 38.15]
33.28 [28.89, 37.99]
26.31 [22.46, 30.54]
23.29 [19.73, 27.28]
37.83 [33.05, 42.85]
29.18 [25.58, 33.06]
29.85 [24.95, 35.24]
24.95 [21.81, 28.38]
45.19 [37.97, 52.62]
25.95 [22.90, 29.25]
48.96 [40.59, 57.40]
27.77 [24.75, 31.02]
46.86 [36.27, 57.75]
28.67 [25.68, 31.85]
44.59 [30.27, 59.87]
24.37 [21.42, 27.58]
57.38 [48.77, 65.57]
27.23 [24.16, 30.53]
42.05 [33.53, 51.07]
28.01 [25.03, 31.20]
53.07 [40.0, 65.74]
27.48 [24.47, 30.70]
50.19 [38.90, 61.45]
27.11 [24.06, 30.40]
45.38 [36.44, 54.64]
24.45 [21.47, 27.77]
55.44 [47.17, 63.42]
27.73 [24.80, 30.87]
66.57 [49.33, 80.29]
20.01 [16.29, 24.34]
36.85 [17.32, 61.92]
35.11 [30.71, 39.78]
60.98 [44.41, 75.35]

Age (years)

Educational level

Occupational status
Self-related health
Smoking habit

Alcohol consumption
Sleep habits
Physical exercise
Obesity
High blood pressure
Asthma
Heart disease
Osteoarthritis
Allergy
Diabetes
Stomach ulcer
Hypercholesterolemia
Depression
Osteoporosis
Prostate problems
Menopausal
symptoms

Note. 95% CI = 95% confidence interval.

*Statistically significant differences in the general population (p < .001). Statistically significant differences in the Romany population (p < .01). All variables
were statistically significant differences between general and Romany populations (p < .001).

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11

Jimnez-Snchez et al.
Table 4. Multiple Regression Results for Prevalence of Migraines in Romany Population in Spain (N = 993)
Variable
Constant
Female
Age: 16-39 years
Occupational status: Unemployed
Self-rated health: Fair/poor/very poor
Sleep habits <8 hours
BMI >30 kg/m2
Osteoarthritis
Allergy
Depression

Coefficient ()

SE

Wald 2

OR

95% CI

3.74
0.44
1.42
0.41
0.75
0.61
0.55
0.95
0.52
0.74

0.47
0.18
0.41
0.17
0.20
0.17
0.21
0.26
0.24
0.23

7.88
2.49
3.12
2.28
3.64
3.57
2.63
3.59
2.18
3.16

<.001
.013
.002
.023
<.001
<.001
.009
<.001
.030
.002

1.56
4.17a
1.51
2.11
1.85
1.75
2.59
1.69
2.09

[4.67, 2.81]
[1.10, 2.21]
[1.78, 9.62]
[1.06, 2.14]
[1.41, 3.15]
[1.32, 2.59]
[1.15, 2.65]
[1.54, 4.36]
[1.05, 2.71]
[1.32, 3.30]

Note. OR = odds ratio; 95% CI = 95% confidence interval; BMI = body mass index.
a. Reference category 65 years.

migraines (14.29%) in the general Spanish population.

Dolinska, Kudlackova, and Ginter (2007) found that the incidence of obesity and being overweight in Slovak Romany
women was higher than in non-Romany women (obese,
12.3% vs. 5.4%; overweight, 26.3% vs. 8.9%, respectively).
In contrast, obesity was not related to the presence of
migraines in the Spanish population (Fernndez-de-LasPeas et al., 2010). Other studies identified risk factors associated with migraines as female gender, low socioeconomic
status, and obesity (Bigal & Lipton, 2006; Scher, Stewart,
Ricci, & Lipton, 2003). This study also showed that the risk
of migraines in the Romany population was 1.75 times
higher in obese people.

Risk Factors for Migraine

in the Romany Population
Romany women exhibited 1.56 times greater probability of
having migraines than men. In fact, other studies conducted
in different countries have shown that women exhibit higher
prevalence of pain (Jimnez-Snchez et al., 2010; Sjgren,
Ekholm, Peuckmann, & Gronbaek, 2009; Wijnhoven, de
Vet, & Picavet, 2006b) and also of migraine (Fernndez-delas-Peas et al., 2010). In the current study, the prevalence
of migraine among women younger than 40 years (4.17
times more) may be related to the much younger Romany
population with a high birth rate and more responsibilities.
Romany women generally do household chores and take
care of children and elders (Lehti & Mattson 2001); more
recently, Romany women are becoming increasingly involved
with contributing to the family income (Fundacin
Secretariado Gitano, 2009). It is possible that familiar stress
and psychological overload, including fewer hours for sleeping, contribute to the development of migraine headache in
this group of women.
The study findings of higher prevalence of migraines,
poorer self-rated health status, and depression among the
Romany population support those of previous studies on the

general population where no Romany population was

included (Melitiche, Lofland, & Young, 2001; Wang, Fuh,
Lu, & Juan, 2001). Roma people with migraines exhibited 2
times greater probability of depression or worse self-rated
health status. Breslau, Lipton, Stewart, Schultz, and Welch
(2003) reported that the relationship between depression and
migraines is bidirectional, since migraine sufferers have a
fivefold increased risk for depression and those with depression had a threefold risk of migraines
Sleeping less than 8 hours/day was also associated with
the presence of migraine in the Romany population, which is
consistent with the general population (Strine, Chapman, &
Balluz, 2006). This association also is supported by recent
studies on sleep impairment as the most common symptom
of migraines as well as the most common precipitating factor
of a headache (Boardman, Thomas, Millson, & Croft, 2005;
Takeshima et al., 2004).
Fifty-one percent (51.7%) of Roma sample were unemployed, which is notable because 92.73% of the sample was
between 16 and 65 years old. However, as Roma women do
not work outside the home, this number also included women
who considered themselves as unemployed. Unemployment
may be higher in the Romany population because of social
exclusion, marginalization, or discrimination that affects
their ability to find employment. Previous studies found
greater prevalence of pain in individuals without employment (Gispert, Rajmil, Schiaffino, & Herdman, 2003;
Jimnez-Snchez et al., 2011; Wijnhoven, de Vet, & Picavet,
2006a). In this study, 35% of Roma sample with migraines
were unemployed.
Migraine was found as a comorbidity of other conditions,
such as the presence of allergies and osteoarthritis. Although
the localized organ of involvement in osteoarthritis was not
determined, there is evidence showing a connection between
the cervical spine involvement and migraines (Bartsch, 2005).
In fact, individuals with neck pain are 6 times more likely to
present with osteoarthritis than those without migraines,
which is expected since facet joint dysfunction such as

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12

Journal of T ranscultural Nursing 24(1)

osteoarthritis is generally considered a nociceptive source of

neck pain (Kirpalani & Mitra, 2008; Manchikanti et al., 2008).

Limitations of the Study

Although the current study used a large randomized sample;
there are a number of limitations, particularly related to the
use of secondary data. First, the questions included in the
survey (secondary data) may be subject to recall errors or a
tendency of people to give socially desirable responses
during interviews, particularly regarding lifestyle habits.
Secondly, the SNHS and NHSRP samples included only
noninstitutionalized people. Third, the SNHS and the
NHSRP did not collect information on migraine characteristics, such as localization, duration, severity, or cause.
Fourth, other variables, such as the number of visits to a
medical doctor, were not evaluated in this study. Nevertheless,
Picavet and Hazes (2003) demonstrated that health surveys
are a valuable source of information for obtaining data about
health problems that are not available from most other
sources of information.
The household response rate for the 2006 SNHS was
64.6% and 80% for the NHSGP. Nonresponders were
replaced by a subject with the same age and sex, using a
random method, until the total sample was reached. No further analysis of nonresponders was conducted (Ministerio de
Sanidad y Consumo, 2010). In both surveys, imputation
methods for missing values were used so the nonresponse
rates for specific variables were not available.

Implications for Practice

The results of this study suggest that migraine headaches
within the Romany population deserve greater scrutiny from
health care professionals. Conducting public health campaigns to promote healthier lifestyle habits among this population attending the features identified in the current study
and those that are potentially modifiable, for example, early
recognition of migraine headaches in younger women and
the relationship with other painful syndromes such as osteoarthritis would be helpful for the society. In fact, the integration of Romany people within the public health community
would help decrease this gross inequity. For instance, campaigns related directly to their housing areas, health professional conscientiousness, or specific womens group
meetings, including educational sessions in their neighborhoods, can help toward this objective.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

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