Background: Migraine is a common and disabling primary headache disorder. Evidence from Saudi Arabia includes national surveys and numerous population subgroups, but differences in sampling and case ascertainment complicate interpretation of prevalence, associated factors, and management outcomes.

Aim:

To synthesise evidence on the prevalence, risk factors, and management of migraine among adults living in Saudi Arabia.

Methods:

PubMed, Scopus, and Web of Science were searched for English-language primary studies published from 2016 to 10 July 2026. Findings were synthesised narratively because populations, diagnostic methods, and outcomes differed. Methodological limitations were assessed descriptively. Two reports with mixed adolescent–adult samples were separated from the adult-focused synthesis when adult-only findings could not be established.

Results:

Of 652 records, 25 reports were retained; 23 contributed to the adult-focused synthesis and two were retained only as mixed-age context. Two national reports analysed the same 2,316 participants. The population-based survey estimated an adjusted one-year migraine prevalence of 25.0%. Other estimates reflected different populations and measures and were not combined into a single prevalence range. Female sex and psychiatric symptoms were associated with migraine in several surveys, without establishing causal direction. Two retrospective onabotulinumtoxinA reports described reductions in headache frequency or disability, but lacked untreated comparison groups. Medication-overuse headache and reported analgesic use were associated with poorer migraine-related quality of life.

Conclusion:

Migraine places a substantial burden on adults living in Saudi Arabia. Population-based estimates should be distinguished from screening positivity and clinic or occupational proportions. Saudi observational treatment reports describe improvement but do not independently establish comparative effectiveness. Heterogeneous, predominantly cross-sectional primary studies limit the certainty of the synthesis.

Bone stress injuries of the lower extremity are among the most consequential overuse conditions in sports medicine and military occupational health, arising when repetitive submaximal loading outpaces bone's capacity to repair and adapt. This review draws together contemporary evidence on the epidemiology, risk factors, diagnosis, and management of these injuries in athletes and physically active populations, with emphasis on work published since 2021, together with foundational earlier literature. Biomechanical exposures are prominent: in a four-year cohort of 1,772 military cadets, each additional movement error on the Landing Error Scoring System raised stress fracture incidence by 15% (IRR 1.15; 95% CI, 1.02-1.31), while flat-footed and asymmetric landings carried more than twofold higher incidence. Foot structure contributes independently, with a higher arch and reduced toe-off angle distinguishing injured recruits. Energy availability, menstrual function, and vitamin D status form a second, modifiable domain: female runners with repeated injuries showed higher cumulative Triad risk and more restrictive eating, and 74% of military trainees with stress fractures were vitamin D insufficient or deficient. Magnetic resonance imaging is the diagnostic reference standard, and MRI grade predicts time to return to sport. Management follows the distinction between low-risk sites, which respond to activity modification, and high-risk sites, where delayed union and progression to complete fracture justify a more aggressive approach. Among professional basketball players, return-to-play time after high-risk fractures did not differ significantly between operative and nonoperative treatment. Screening that combines movement quality, energy availability, and vitamin D status offers a practical route to reducing injury burden.

Background: Rotator cuff–related shoulder pain is among the most common problems in athletes whose sport demands repeated overhead loading. Rehabilitation is first-line care, yet clinicians have little guidance on how to sequence it or on when an athlete is ready to compete again.

Aim: To provide clinicians with a practical framework for assessing rotator cuff–related shoulder pain in the overhead athlete, staging rehabilitation and structuring the return-to-sport decision.

Methods: This clinical practice review draws on seven clinical studies of rehabilitation in overhead athletes and four guideline, consensus and narrative sources. Outcome values were extracted from the published tables of each study and compared with published minimal clinically important differences where these were available. The review is not systematic and does not aim for exhaustive coverage.

Results: Trials comparing exercise with no treatment or a weak comparator reported benefit. On patient-reported outcomes, no comparison between two active programmes produced a difference that was both statistically significant and larger than the published minimal clinically important difference: physio-yogic versus scapular recruitment exercise, p=0.180; scapular dyskinesis–based versus multimodal therapy, 5.98 points on the Shoulder Pain and Disability Index against published thresholds of 8 to 20.6 points; kinesiotaping added to rehabilitation versus rehabilitation alone, all differences below threshold. After arthroscopic supraspinatus repair in 17 Olympic volleyball athletes, all returned to their pre-injury level, at a mean of 6.9 months to sport and 12.4 months to performance. None of the 22 return-to-sport criteria drawn from current guideline and consensus sources is a validated threshold for the overhead shoulder.

Conclusion: Supervised, progressively loaded exercise appears to be the effective component of rehabilitation in these athletes, and no specific exercise programme has outperformed another credible programme on patient-reported outcomes. Clinicians are better served by a framework for sequencing and progressing rehabilitation, with explicit return-to-sport criteria, than by a fixed protocol.

Introduction:

Osteoarthritis is the most common type of arthritis. It is characterized by degenerative changes in the articular cartilage and other joint tissues, with variable synovial inflammation. Its prevalence is rising worldwide, and an estimated 528 million people were affected in 2019.

Methods:

A descriptive cross-sectional study was conducted among residents of Bisha aged 18 years or older. Data were collected with an Arabic, self-administered online questionnaire using convenience sampling. A total of 442 respondents took part. Statistical analysis was performed with SPSS version 26.

Results:

Cartilage degeneration was identified as the mechanism of osteoarthritis by 47.5% of respondents, while 52.5% chose another response or were unsure. Osteoarthritis was recognized as a chronic disease by 62.0%, and 64.7% recognized that it is not rare. Knowledge of symptoms varied: 48.4% knew that joint pain is not the only symptom and 64.9% were aware that osteoarthritis can reduce joint mobility. For risk factors, 30.8% did not know whether genetics contributes, 74.4% recognized aging as a contributor, and 48.0% correctly rejected equal prevalence in males and females. For diagnosis, 58.8% stated that physical examination and X-rays are used. No statistically significant association was found between knowledge category and sex (p = 0.615), age (p = 0.522) or education level (p = 0.839).

Conclusion:

Respondents showed substantial gaps and misconceptions in their knowledge of osteoarthritis. Many understood that the disease is chronic, but misunderstandings about its causes, risk factors and diagnostic methods persisted.

Purpose: To describe uncorrected distance visual acuity over the first 6 months, and postoperative intermediate and near acuity, refraction, spectacle use, photic phenomena and satisfaction, after cataract surgery with an extended depth-of-focus (EDOF) intraocular lens (IOL).

Setting: Private eye centre, Dammam, Saudi Arabia.

Design: Retrospective single-centre case series.

Methods: Forty-five eyes of 25 patients (mean age 53.4 ± 9.6 years) underwent phacoemulsification with implantation of one of two EDOF IOLs (Bi-Flex ELON, Medicontur; Synthesis+, Cutting Edge) between August 2022 and September 2023. Uncorrected distance visual acuity (UDVA) was recorded before surgery and at 2 weeks and 1, 3 and 6 months. Intermediate and near acuity, binocular acuity, refraction, satisfaction, spectacle use and photic phenomena were recorded at one further postoperative assessment. Inferential analyses used the first operated eye of each patient (n = 25); results for all 45 eyes are descriptive.

Results: In first eyes, mean UDVA improved from 0.45 ± 0.23 to 0.07 ± 0.09 logMAR (change −0.38, 95% confidence interval [CI] −0.47 to −0.28; p < 0.001), and 85% of this change had occurred by 1 month. At 6 months, 73% of all eyes had UDVA of 20/25 or better. Uncorrected intermediate and near acuity were 20/25 or better in 67% and 76% of eyes (84% and 89% with distance correction). Postoperative spherical equivalent was −0.30 ± 0.72 D and was within ±0.50 D of emmetropia in 58% of eyes. Twenty-two of 25 patients (88%) reported needing no spectacles for daily activities, and 24 (96%) were fully or fairly satisfied with distance vision. Eleven patients (44%) reported at least one photic phenomenon, most often halos (28%). The eight eyes with previous radial keratotomy, vitrectomy or amblyopia had a mean 6-month UDVA of 0.23 logMAR, compared with 0.06 logMAR in the other 37 eyes.

Conclusions: After EDOF IOL implantation, about three quarters of eyes reached uncorrected acuity of 20/25 or better at distance and near, and most patients reported not needing spectacles. Photic phenomena were reported by 44% of patients. Without a control group, these outcomes cannot be attributed to the lens designs.

Background: Crohn's disease (CD) and ulcerative colitis (UC) are the two main subtypes of inflammatory bowel disease (IBD) and are usually explored as a single entity, obscuring the specific sociodemographic and comorbidity patterns of each entity.

Aim: To explore and compare the sociodemographic and chronic comorbidity patterns of United States (US) adults with a self-reported diagnosis of CD versus UC.

Methods: This nationally representative, cross-sectional analysis utilized data from the 2023–2024 National Health Interview Survey (NHIS) on a total of 62,151 adults. The diagnosis of CD (n = 351) and UC (n = 861) was established by self-reported physician diagnosis and analyzed as two independent case groups, with each group compared against respondents without that diagnosis. Weighted chi-square and t-tests were utilized to compare sociodemographic and comorbidity profiles; univariate and multivariate regression analyses (adjusted for age, sex, body mass index, smoking status, and univariably significant comorbidities) were used to estimate crude and adjusted odds ratios (aOR) for 15 comorbidities.

Results: In our sample, individuals with a diagnosis of CD and UC were significantly older than their comparators (52.6 ± 17.8 years and 56.8 ± 17.3 years, respectively, both p < 0.001). In unadjusted analysis, UC was significantly associated with female sex. Worse self-rated health and a significantly higher unadjusted prevalence of most comorbidities examined were reported by both groups. After multivariate adjustment, CD remained independently associated with asthma (aOR 1.41), psoriasis (aOR 1.96), hepatitis (aOR 2.41), arthritis (aOR 1.59), and colorectal cancer (aOR 2.14). UC, on the other hand, remained independently associated with eight comorbidities, including stroke, angina, dyslipidemia, psoriasis, depression, anxiety, arthritis, and chronic obstructive pulmonary disease (aORs 1.25–2.50). Obesity showed an independent association with lower odds of UC after adjustment (aOR 0.77), whereas the association with female sex was no longer significant (aOR 1.14).

Conclusions: Both CD and UC showed a significant presence of chronic comorbidity, but their adjusted comorbidity profiles differed, with UC showing independent associations with more comorbidities than CD, although the two diseases were not compared directly. These findings support the importance of disease-specific approaches rather than combined ones in the screening of IBD patients.

Background: Tonsillitis is common and often viral; group A streptococcus (Streptococcus pyogenes) is its principal bacterial cause and the main reason to prescribe antibiotics. Saudi data on medical students' knowledge of it are lacking. We assessed perceived and actual knowledge of tonsillitis among undergraduate medical students at the University of Bisha, Saudi Arabia, and factors associated with awareness.

Methods: In a cross-sectional online survey (March–April 2025) of 320 consenting medical students recruited by convenience sampling, an adapted, pilot-tested questionnaire (Cronbach's alpha = 0.832) covered sociodemographic data, eleven self-rated (perceived) and five multiple-choice (actual) knowledge items; a score of at least 9 of 16 defined awareness. Associations were examined with chi-square or Fisher's exact tests and binary logistic regression (adjusted odds ratios [aOR] with 95% confidence intervals [CI]).

Results: In total, 204 students (63.8%) were classified as aware, and 93.1% agreed that the tonsils have a defensive immune role. Self-ratings exceeded test scores on three of four comparable topics: 61.9% said they knew the bacterial causes, but 45.0% identified S. pyogenes, and 62.5% said they knew the symptoms of streptococcal tonsillitis, but 43.4% recognized all of them. Only 46.9% agreed that tonsillitis is infectious. Awareness was associated with age (p = 0.004) and academic year (p = 0.041) but not significantly with gender (p = 0.057). After adjustment, age 24–28 years (aOR 4.84; 95% CI 1.54–15.26) and female gender (aOR 1.90; 95% CI 1.15–3.14) were independently associated with higher awareness and a monthly income of 5,000–10,000 Saudi riyals with lower awareness (aOR 0.36; 95% CI 0.14–0.94); academic year was not.

Conclusion: Students' self-rated knowledge of tonsillitis exceeded their tested knowledge on three of four topics, most clearly for its bacterial cause and the symptoms of streptococcal tonsillitis. Teaching should target these gaps, and knowledge should be tested with objective questions.

Background: Cervical spine injuries can result in permanent neurological impairment, and inappropriate first-aid management may aggravate spinal cord damage. Public recognition of these injuries and knowledge of safe initial responses are therefore essential for preventing secondary harm.

Aim: This study aimed to assess awareness, attitudes, and intended first-aid practices regarding cervical spine injuries among adults in Al-Ahsa, Saudi Arabia, and to identify the factors associated with these outcomes.

Methods: A cross-sectional survey was conducted among 389 adults residing in Al-Ahsa. Data were collected electronically using a structured questionnaire covering sociodemographic characteristics, awareness, attitudes, and intended first-aid practices. Descriptive statistics and multiple linear regression analyses were used to summarize participants’ responses and identify associated factors.

Results: The mean awareness score was 63.8%, and 60.4% of participants had good awareness (score ≥60%). The mean attitude and intended practice score was 87.7%, and 92.8% of participants had a positive score. The importance of early recognition in preventing complications was correctly identified by 84.1% of participants; however, only 39.3% recognized all listed complications. Most participants reported that they would maintain head, neck, and spinal alignment (94.3%), contact emergency services before initiating first aid (93.8%), and avoid unnecessary patient movement while seeking emergency assistance (93.6%). First-responder training was independently associated with higher awareness and more favorable attitude and intended practice scores (both P<0.001). Female gender was also independently associated with a higher attitude and intended practice score (P=0.001).

Conclusion: Participants reported highly positive intended first-aid responses, but important knowledge gaps remained, particularly regarding the complications of cervical spine injuries. Expanding structured, practical first-responder training may improve public knowledge and promote safer early management of suspected cervical spine injuries.

Introduction: Bowel ischemia is a time-sensitive vascular emergency that can cause intestinal necrosis and death when diagnosis and treatment are delayed. Public understanding of this condition in Saudi Arabia remains poorly characterized. This study assessed awareness and knowledge of bowel ischemia among adults in Al-Ahsa and identified factors associated with knowledge.

Methodology: This community-based cross-sectional study included 390 non-healthcare adults residing in Al-Ahsa. Data were collected electronically through an expert-reviewed, pilot-tested, self-administered questionnaire. Ten knowledge items generated a score of 0–10; scores below 6 represented poor knowledge. Multiple linear regression was used to identify associated factors.

Results: Only 43 participants (11.0%) had previously heard of bowel or intestinal ischemia. The mean knowledge score was 3.76 ± 3.56 out of 10, demonstrating poor knowledge. Healthcare professionals were the leading information source among aware participants (32.6%). The best-recognized concepts were the need for urgent assessment of sudden severe unexplained abdominal pain (mean item score = 0.57) and the benefit of early diagnosis and treatment (0.56). The least-recognized concepts were blood in the stool as a possible manifestation (0.25) and the definition of bowel ischemia (0.29). Previous awareness independently predicted a higher knowledge score (B = 4.332, p < 0.001); gender, age, and educational level were not significant predictors.

Conclusion: Adults in Al-Ahsa had limited awareness and important knowledge gaps regarding bowel ischemia. Clinician-led education delivered through trusted digital platforms should emphasize its definition, warning manifestations, risk factors, and need for urgent evaluation.