The Prevalence, Classification and Characteristics of Headache in Medical Students of Karachi, Pakistan Saqib Kamran Bakhshi Huda Naim Ahmed Salman

OBJECTIVE  Headache – Some facts  Study Objectives and Methods  Results  Discussion  Conclusion Outline

OBJECTIVE  Frequently experienced neurological complain worldwide  Forty seven percent adults had atleast one episode of headache during a year  Among 10 most disabling conditions in the world  High prevalence in medical students as medical education is stressful and demanding WHO Headache Disorders Fact Sheet 2012 Headache – Some Facts

OBJECTIVE Regional Sketch of Headache in Undergraduate Medical Students Pakistan: ?? Oman: 96.8% Nigeria: 88.3% Palestine: 95.2% India: 68% Iran: 58.7% Turkey: 41.02%

OBJECTIVE  Determine prevalence of headache in undergraduate medical students of Karachi  Classify and determine presence or absence of various associations Study Objectives

 Study Design: Cross-sectional study  Study Setting: Students from seven medical colleges of Karachi  Study Duration: 1st January – 30th June 2012  Inclusion Criteria: Belongs to any of the 5 years of MBBS  Exclusion: who had co-morbids such as dental disease, sinusitis, fever or constitutional feature with headache  Ethical approval: Dow University METHODS

 Headache We had defined as occurrence of more than a single episode of headache of more than 2 hours duration in the last one year. Those students who had had less a single episode of headache of less than 2 hours were categorized with those who did not suffer any headaches during last one year. Operational Definition

 Self-designed structured questionnaire for data collection  Inquired from students about occurrence of headaches during past one year  International Classification of Headache 2nd edition was usedClassification  Epworth Sleepiness Scale (ESS) was used to assess the tendency of excessive day-time sleepiness Data Tools and Collection

 Statistical analyses were performed using SPSS (Version 16)  Data of categorical variables were presented as counts and percentages  Data of continuous variables were presented as the mean and standard deviation.  Categorical data was analyzed using Chi square test  P-value of < 0.05 was considered to be significant. Analysis

 Participants = 402  Males = 32.33% (n=130)  Females = 67.66% (n=272)  Mean age  Males = 21.22years  Females = years  Prevalence of Headache = 87.8%  Females = 91.5%  Males = 80% Results

2.27% 75.35% 9.34% Without aura 8.5% With aura Both Tension Type and Migraine = 3.97%

 25% suffering from headache have a positive family history  50% suffered headaches in afternoon after getting free from clinical posting  Common triggers: stress, anxiety, fatigue, abnormal sleep, loud noise and hunger  Other triggers: dehydration, bright lights, menstrual cycles, physical exertion and weather changes  60% did not take any medications for headaches Results

Headache Treatment Pattern

 Only significant factor: hectic study schedule with 272 (67.66%) reporting co-occurrence  No statistical significance: Association of Headache with Various Factors  peer pressure  low exam grades  financial issues  separation of parents  long college to home distance  lack of time management  suffering from a chronic illness  parental pressure like money, friends and relationships  death of a close family member  any family member suffering from a chronic illness

 Headache prevalence of 87.8% observed is much higher than global (47%) as well as rates from our neighbors India and Iran  Triggers identified (chiefly stress and anxiety) are similar to general population studies. However significant association was found between headache and hectic study schedule  Tension Type Headache and migraine were common in female including co-occurrence  Cluster headaches more common in males Discussion

 Globally, chocolates, ice cream, pizza, milk, peanut butter and egg are dietary triggers of headache, however, our study did not find them a significant precipitant of migraine  Past studies conducted in India also cited these dietary factors non-significant triggers  This might be attributed to different dietary habits in subcontinent as compared to the Western countries Discussion

 Strategic planning and physical activities may help to cope up with hectic study schedule  Role of medical curriculum needs to be assessed  Reducing headache occurrence will improve working performance  Further studies are needed for more in-depth classification and for analyzing other aspects. CONCLUSION

Thank You

 Tension Type Headache Those having characteristically bilateral pain occurring for minutes to days, pressing or tightening in nature and of mild to moderate intensity, not aggravated with routine exertion; associated with either photophobia or phonophobia but no nausea, were considered as having TTH. Operational Definitions

 Migraine Headache Migraine headaches were defined as those lasting 4-72 hours, usually unilateral, having pulsating nature, moderate or severe in intensity, worsening with routine exertion and associated with nausea and/or photophobia and phonophobia. Migraine was further classified as with-aura or without-aura.. Operational Definitions

 Cluster Headaches Cluster headaches included episodes of severe, strictly unilateral pain which is orbital, supraorbital, temporal or in any combination of these sites, occurring for minutes and occurring from once every alternate days to 8 times a day. Cluster headaches are commonly associated ipsilaterally with conjunctival injection, lacrimation, nasal congestion or rhinorrhoea Operational Definitions Back