|Year : 2020 | Volume
| Issue : 4 | Page : 285-289
Perceived cause and characteristics of headache among undergraduate medical students of Government Medical College, Srinagar: A cross-sectional study
Tanzeela Bashir Qazi, Sheikh Mohd Saleem, Muhammad Salim Khan
Department of Community Medicine, Government Medical College, Srinagar, Jammu and Kashmir, India
|Date of Submission||30-Apr-2020|
|Date of Decision||14-May-2020|
|Date of Acceptance||03-Jun-2020|
|Date of Web Publication||19-Oct-2020|
Dr. Tanzeela Bashir Qazi
Department of Community Medicine, Government Medical College, Srinagar, Jammu and Kashmir
Source of Support: None, Conflict of Interest: None
Background: Headache is prevalent worldwide and it affects people in almost all age groups, irrespective of their gender, educational level, socioeconomic status, and occupation. The aim of this study was to determine the characteristics, perceived cause, and medical consultation sought by undergraduate medical students of Government Medical College, Srinagar. Materials and Methods: A descriptive cross-sectional study was conducted among undergraduate medical students of Government Medical College, Srinagar. One hundred students participated in the study. A 12-item structured questionnaire which included cause, aggravating factors, relieving factors, and frequency of headache was distributed among these students to be filled by them after a proper written consent. Results: Out of 100 participants, 60 were female. The most commonly reported cause of the headache was stress (25%), followed by disturbed sleep cycle (18%) and mobile phone use for social media in (13%) students. Aggravating factors such as less hours of sleep duration were reported by 40% of students and 27% reported having headache after not eating for several hours. Majority (51%) of the participants reported described pain as a sensation of constant pressure, which was mainly concentrated in the frontal region. Family history was found among 18% of students and only 22% had consulted doctor for headache symptoms. Conclusion: Stress was identified as the most common reported cause of headache and sleep as the most reported relieving factor among medical students of Government Medical College, Srinagar.
Keywords: Frontal headache, headache, medical students, stress
|How to cite this article:|
Qazi TB, Saleem SM, Khan MS. Perceived cause and characteristics of headache among undergraduate medical students of Government Medical College, Srinagar: A cross-sectional study. Curr Med Issues 2020;18:285-9
|How to cite this URL:|
Qazi TB, Saleem SM, Khan MS. Perceived cause and characteristics of headache among undergraduate medical students of Government Medical College, Srinagar: A cross-sectional study. Curr Med Issues [serial online] 2020 [cited 2021 Mar 1];18:285-9. Available from: https://www.cmijournal.org/text.asp?2020/18/4/285/298596
| Introduction|| |
Headache is one of the most common neurological disorders. It is prevalent worldwide and affects people in almost all age groups, irrespective of their gender, educational level, socioeconomic status, and occupation. These headache disorders are characterized by recurrent pains and are usually associated with personal and societal burdens, disability, damaged quality of life, and financial implications. The pain usually occurs when peripheral nociceptors are stimulated in response to tissue injury, visceral distention, or other factors. Pain can also result when pain-producing pathways of the peripheral or central nervous system are damaged or activated inappropriately. The Global Burden of Disease study ranks headache disorders as the second leading cause of years lived with disability worldwide.
Globally, it has been estimated that the prevalence of headache disorder among adult population is about 50%. Half to three quarters of adults aged 18–65 years in the world have experienced headache last year, and among those individuals, 30% or more have reported migraine. Headache (on fifteen or more days) every month affects 1.7%–4% of the world's adult population. Studies conducted in southern part of India showed the prevalence of primary headache to be around 62% and that of migraine as 25.2%. Another study conducted in Srinagar district of Kashmir valley showed the prevalence of tension-type headache and migraine in students to be 50.99 and 26.98%, respectively.
It had been found that medical students form a vulnerable group to these headaches. The undergraduate medical course, MBBS, in India lasts for 5½ years with rigorous and demanding curriculum. Medical students have to assimilate vast amounts of information and perform well in classes and examinations all through their long years of training. Medical students are usually working hard and require constant concentration, which may cause much stress and sleep disturbances, subjecting them to high stressful conditions. All these factors contribute in making them a vulnerable group, especially because of sleep deprivation and stress greater than in the general population. Moreover, there are studies which have shown a higher prevalence of headache among medical students. Frequent headaches can adversely affect the academic, social, and personal lives of students and can have life-altering consequences.
Several studies have been conducted both in India and abroad on prevalence, symptoms, and characteristics of headache. Study subjects for most of these studies are general population or patients visiting hospitals. There is a paucity of information on prevalence, pattern, characteristics, and predictors of headache among medical student population in India. Studies on the prevalence of headache and its associated factors among medical students will help in identifying high-risk groups among the study population, triggers and knowing the impact of headache on their quality of life. Thus, the present study was conducted with the aim to determine the characteristics, perceived cause of headache, and medical consultation sought by undergraduate medical students of Government Medical College, Srinagar.
| Materials and Methods|| |
This was a cross-sectional study carried out at Government Medical College, Srinagar, Jammu and Kashmir, India, among undergraduate MBBS Students from March 2019 to April 2019. The MBBS undergraduate students were chosen for the study considering the recent studies which highlighted stress among this cohort.
Study participants were the MBBS undergraduate students and they were selected for this study using the convenience type of sampling as majority are busy in regular studies, ward postings, and attending lectures during the college hours. At first, a lecture was given to medical students informing them about the conduct of the research. Information about the study, such as its purpose, the procedures, and importance, was given and any queries from students were answered by the investigator. A total of 120 were initially contacted, among which 115 satisfied the inclusion criteria for this study. A self-administered validated questionnaire was distributed among the participants. The questionnaire included the self-perceived cause, aggravating factor, relieving factor, and other associated factors of headaches. They were asked to return the questionnaire back the following day or two. Among those who received the questionnaire, we received only 103 questionnaires back from the participants. On analyzing the questionnaires, three were found to be incomplete and were excluded from the final analysis.
Second-semester medical students of Government Medical College, Srinagar, who have experienced headache in the last 6 months were included in the study.
Students with a history of injury to head, seizure disorders, or any neurological disorder were excluded.
Questionnaire was based on various characteristics of headache. These included event or cause starting the headache, aggravating and relieving factors, pain intensity, association with stress or eating, character of pain, region of pain, radiation of pain, number of headache episodes per month, number of hours for which each attack lasts, medical help sought for headaches, and any headache history.
The data were entered into Microsoft Excel spreadsheet 2007. Frequency and percentages were calculated for the variables using Microsoft Excel 2007.
Written informed consent was obtained from study participants after explaining them the objectives of the study.
The study had no ethical issue related to animal or human experimentation. The study was presented to the institutional ethics committee and necessary permission was permitted. Moreover, the information of the study participants was kept anonymous and was used for this study purpose only.
| Results|| |
A total of 120 were initially contacted, among which 115 satisfied the inclusion criteria for this study. Among those who received the questionnaire, we received only 103 questionnaires back from the participants. On analyzing the questionnaires, three were found to be incomplete and were excluded from the final analysis. Out of the total 100 participants, 60 (60%) were female.
The perceived cause of headache among undergraduate medical students is described in [Table 1]. As reported by the students, stress, disturbed sleep cycle, and excessive use of mobile phone were the most common perceived causes of headache among them. Stress and disturbed sleep cycle were reported by 25 (25%) and 18 (18%) of the participants, respectively.
|Table 1: The commonly perceived causes of headache among the study participants|
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[Table 2] shows the aggravating factors for headache and it was found that less hours of sleep (18; 18%) and excess mobile phone use (12; 12%) were the common causes behind this. Skipping meal was reported by only (8; 8%) participants.
Fifty students (50%) reported of having mild headache (discomfort/annoyance). Thirty-nine students (39%) experienced headache of moderate intensity (hurts/bearable sensation), whereas 11 students (11%) reported that their headache was of severe intensity (sharp/intense/unbearable).
Among the study participants, 51 (51%) reported a constant pressure over the head, while 16 (16%) reported exploding type of headache when asked about the nature of their headache. Moreover, in majority, headache was mainly focused in the frontal region (24%), followed by occipital region (21; 21%) [Table 3].
|Table 3: Nature of headache and its regional focus among study participants|
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Relieving factors for headache among the study participants are described in [Table 4]. As reported, sleeping (45; 45%) was the most common method used by the students to relieve their headache, followed by rest (15; 15%).
Majority of the participants (70; 70%) had maximum of 1–2 episodes of headache per month, while 23 (23%) reported more than 3–6 episodes per month. Duration of 1–2 h of headache was reported by 63 (63%) study participants, while 46 (46%) participants reported taking >2 pills for their headache each month [Table 5].
|Table 5: Number of episodes of headache, duration of each episode, and number of pain relieving medication taken, among the study participants (each month)|
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History associated with each headache is described in [Table 6]. Most of the participants (30; 30%) reported that physical exertion makes their headache worse, while 18 (18%) reported having a family history of headaches.
|Table 6: History of associated symptoms, aggravating, and relieving factors of headache among the study participants|
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| Discussion|| |
The present study was conducted among undergraduate medical students of Government Medical College, Srinagar. In this study, we found that the most commonly reported cause of headaches among the undergraduate medical students was stress, followed by disturbed sleep cycles. These results are in concordance with the results seen in a similar study conducted in Kuwait by Al-Hashel et al., which reported stress (24.9%) and irregular sleep (20.8%) as the most common factors contributing to headache among medical students. Another study conducted by Menon and Kinnera in India among medical students also reported sleep disturbance as one of the major causes of headaches contributing to 53.4%.
The aggravating factors are the factors that, alone or in combination, induce headaches in susceptible individuals. About 18% of the participants believed that lack of sleep triggers their headache, which was considered as one of the common aggravating factors among them. Moreover, such factors varied among the students. This may be attributed to the fact that a medical school curriculum requires constant concentration, continuous effort, extensive reading, and a lot of hard work which can lead to fewer hours of sleep and physical exertion. Some studies support the fact that poor sleep leads to an increased risk of a headache., Other respondents consider excess mobile use, skipping meals, and extreme weather conditions as a trigger factor for their headaches. There are studies which have shown that smart phone users report headache as one of the most frequent complaints.
Depending on the pain score, the pain severity was categorized as mild, moderate, and severe. Pain intensity was found to be mild in 50% of the students and a very less percentage (11%) reported having severe pain. These results coincide with a study conducted among medical students of Udaipur, in which 50.5% of the students reported having mild headaches. However, these findings are in contrast to a study conducted by Balakrishnan et al. in India, in which 44% of the participants reported having severe pain.
The majority of the participants (51%) reported their pain as a sensation of constant pressure and only 2% described it as a burning pain. Similar results were found in a study conducted by Bhat et al. among dental professionals of India, in which maximum participants (24%) were having pressure type of pain and burning sensation of pain was felt by only 1.3% of the participants. Our findings indicate that 20% of the students had bilateral headaches. Bilateralism of headaches was found to be more common than unilaterality as supported by other studies also. These findings are in contrast to the results derived by Nandha ad Chhabra among dental students in India who suggested that headache in their interest of population was unilaterally localized.
The most commonly reported relieving factor among undergraduate students was sleep (45%) and similar findings were found in a study conducted by Haque et al. in Dhaka, in which they reported that maneuvers such as sleep and rest were adopted by the participants for improving their headache. Dark quiet room was the relieving factor for 8% of the students and muscle massage for 4%.
In the present study, the majority of the participants (70%) experienced 3–5 episodes of headache in a month and 7% reported having more than 6 episodes/month. These findings are consistent with an Indian study done by Balakrishnan et al. in Tamil Nadu where the most prevalent episodes of headache were four episodes per month.
Thirty percent reported physical activity as being an aggravating factor for their headaches. Participants who had a positive family history of headaches were found to be 18%, which was lesser compared with the study done by Agarwal et al. in India where 26% of patients had a family history of headache.
Limitation of the study
- The students were not interviewed by neurologist for confirmation of diagnosis
- The use of a self-administered questionnaire might create a misunderstanding of some asked questions with the risk of subjectivity in the answers.
Further studies should be conducted focusing on identifying headache subtypes and exploring more details.
| Conclusion|| |
Headache is the one of the most common neurological disorders and is prevalent among undergraduate medical students of Government Medical College, Srinagar. Stress was identified as the most common reported cause of headache and sleep as the most reported relieving factor among medical students. Aggravating factors are same as other population but less hours of sleep being most prevalent in this study.
The authors are highly thankful to all the respondents who took part in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
Research quality and ethics statement
The authors of this manuscript declare that this scientific work complies with reporting quality, formatting, and reproducibility guidelines set forth by the EQUATOR Network. The authors also attest that this clinical investigation was determined to require Institutional Review Board/Ethics Committee review. We also certify that we have not plagiarized the contents in this submission and have done a plagiarism check.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]