Screening-positive migraine in the Arab world: Gut–brain comorbidities and modifiable dietary and lifestyle factors in 3317 adults across multiple countries

Background Migraine is a debilitating neurological disorder that imposes a substantial global health burden, with a substantial burden in the Arab world. It frequently coexists with gastrointestinal disorders, particularly irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD), potentially reflecting shared gut-brain axis mechanisms. Objective The present study aimed to estimate the prevalence of screening-positive migraine and examine its associations with IBS and GERD, while identifying sociodemographic, dietary, and lifestyle factors associated with screening-positive migraine among adults across Arab countries. Methods A multinational cross-sectional study was conducted between September 2025 and March 2026 using a validated bilingual (Arabic/English) online self-administered questionnaire distributed to adults across Arab countries. The questionnaire assessed sociodemographic characteristics, personal and dietary habits, migraine using the Migraine Screening Questionnaire (MS-Q), IBS according to the Rome IV criteria, and GERD using the GERD Questionnaire. Univariate and hierarchical multivariable logistic regression analyses were performed to identify factors associated with a positive migraine screen. Results Of 3317 participants, 59.7% were female, 46.4% were aged 18–24 years, 77.9% lived in urban areas, and 24.5% had a family history of migraine. Regarding lifestyle factors, 29.7% reported no physical activity, 33.6% slept ≤6 h/night, 44.0% reported low fluid intake (<2 liters/day), 24.9% frequently consumed spicy food, 8.7% ate fast food daily, and 62.2% reported using self-medicated painkillers. A total of 22.4% screened positive for migraine, with 20.5% reporting comorbid IBS and 21.8% reporting comorbid GERD. Common triggers were sleep disturbance, noise, anxiety, and stress while resting, sleep, and self-medicated painkillers were the main relieving factors. Female sex, family history of migraine, IBS, GERD, daily fast-food consumption, and spicy-food intake were independently associated with higher odds of screening-positive migraine. In contrast, higher physical activity levels, adequate sleep duration, more frequent daily meals, and higher family income were associated with lower odds of screening-positive migraine. Conclusion This multinational study found a high prevalence of screening-positive migraine, with strong independent associations with IBS and GERD. Several potential modifiable lifestyle and dietary factors were also associated with screening-positive migraine, highlighting opportunities for integrated gut-brain axis care and targeted public-health interventions promoting regular meals, adequate sleep, physical activity, and reduced fast-food/spicy-food consumption in the region.