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

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

3. 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

4. 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%

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

6.  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

7.  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

8.  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

9.  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

10.  Participants = 402  Males = 32.33% (n=130)  Females = 67.66% (n=272)  Mean age  Males = 21.22years  Females = 20.47 years  Prevalence of Headache = 87.8%  Females = 91.5%  Males = 80% Results

11. 2.27% 75.35% 9.34% Without aura 8.5% With aura Both Tension Type and Migraine = 3.97%

12.  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

13. Headache Treatment Pattern

14.  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

15.  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

16.  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

17.  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

18. Thank You

19.  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

20.  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

21.  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 15-180 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