ByBy

Prof, Prof, Amal El-motemAmal El-motem

Dr, Dr, Karam AminKaram Amin

Dr,Dr, Ahmed Badawy Ahmed Badawy

Dr,Dr, Nessma Abd elmonemNessma Abd elmonem

Headache is an important general health Headache is an important general health problem .Severe and frequent headache problem .Severe and frequent headache episodes constitute a significant burden for episodes constitute a significant burden for both the individual and the community (4). both the individual and the community (4). Population-based studies of headache are Population-based studies of headache are numerous .However, fewer studies have been numerous .However, fewer studies have been conducted on headache frequency in the young conducted on headache frequency in the young adult population. adult population.

Headache disorders impose recognizable Headache disorders impose recognizable burden on sufferers including substantial burden on sufferers including substantial personal suffering, impaired quality of life personal suffering, impaired quality of life and financial cost. Repeated headache attacks, and financial cost. Repeated headache attacks, and often the constant fear of the next one and often the constant fear of the next one damages family life, social life and damages family life, social life and employment.employment.

Although the epidemiology of headache disorders is Although the epidemiology of headache disorders is only partly documented, taken together, headache only partly documented, taken together, headache disorders are extraordinarily common. Few disorders are extraordinarily common. Few population-based studies exist for developing population-based studies exist for developing countries where limited funding and large and often countries where limited funding and large and often rural populations, coupled with the low profile of rural populations, coupled with the low profile of headache disorders compared with other diseases, headache disorders compared with other diseases, prevent the systematic collection of information. prevent the systematic collection of information.

The aim The aim of this study was to determine the of this study was to determine the frequency and types of headaches among frequency and types of headaches among medical student in Zagazig University, medical student in Zagazig University, Sharkia Governorate.Sharkia Governorate.

Study populationStudy populationThis study was conducted on medical student in This study was conducted on medical student in

zagazig university sharkia governorate. A structured zagazig university sharkia governorate. A structured questionnaire was developed and then distributed to questionnaire was developed and then distributed to medical students. All students enrolled in the medical students. All students enrolled in the University are of the same ethnic background. The University are of the same ethnic background. The study sample was 420 students from all grades from study sample was 420 students from all grades from the total number of students who 4222 students, only the total number of students who 4222 students, only 372 students complete the questionnaire (156 males 372 students complete the questionnaire (156 males and 216 females) age range between 17- 23 year old, and 216 females) age range between 17- 23 year old,

attending all gradesattending all grades..

Study tool: the questionnaireStudy tool: the questionnaire

A structured questionnaire containing both A structured questionnaire containing both open-ended and close-ended questions was open-ended and close-ended questions was developed for this study .Before the start of developed for this study .Before the start of the project and collection of data, the the project and collection of data, the questionnaire was pilot-tested in 50 students. questionnaire was pilot-tested in 50 students. Based on the preliminary results generated Based on the preliminary results generated through the pilot study, the questionnaire was through the pilot study, the questionnaire was modified and finalized. It contained four modified and finalized. It contained four sections.sections.

The first was the demographic section, which The first was the demographic section, which contained questions regarding age, gender, contained questions regarding age, gender, type of colleges, place of residence, wearing type of colleges, place of residence, wearing eye glasses and family history of headaches. In eye glasses and family history of headaches. In this section, there was also a question this section, there was also a question investigating whether the student had investigating whether the student had experienced headache episodes in the previous experienced headache episodes in the previous year and the frequency of these episodes. year and the frequency of these episodes.

The term ‘headache’ included all forms of The term ‘headache’ included all forms of headache and was defined to the participants headache and was defined to the participants as any acute or chronic pain experienced as any acute or chronic pain experienced within the cranial cavity. The second section within the cranial cavity. The second section of the questionnaire was used to assess the of the questionnaire was used to assess the quality and severity of headache episodes quality and severity of headache episodes through 10 questions. The third section through 10 questions. The third section contained 14 yes–no questions regarding contained 14 yes–no questions regarding potential headache triggers. The final section potential headache triggers. The final section contained questions related to management contained questions related to management and medications consumed by the participants and medications consumed by the participants during the episode.during the episode.

Collection of dataCollection of data

Data will be collected by means of an interview based Data will be collected by means of an interview based on the questionnaire described above. The interview on the questionnaire described above. The interview is carrying out under the supervision of the is carrying out under the supervision of the supervisors. All students complaining of headaches supervisors. All students complaining of headaches will be subjected to the followingwill be subjected to the following

-General examination-General examination

-Full history taking.-Full history taking.

-Thorough neurological examination.-Thorough neurological examination.

-Laboratory investigations. -Laboratory investigations.

-Radiological investigations including:-Radiological investigations including:

- CT or MRI of the brain:- CT or MRI of the brain:

- EEG- EEG

Diagnosis of headacheDiagnosis of headache

The diagnosis of pediatric migraine was made using The diagnosis of pediatric migraine was made using HIS revised criteria 12 and that of TTH was HIS revised criteria 12 and that of TTH was made with HIS criteria. 13 The same neurologist, made with HIS criteria. 13 The same neurologist, based on the student’s questionnaire, based on the student’s questionnaire, supplemented with parent and teacher supplemented with parent and teacher information data, performed the diagnosis of information data, performed the diagnosis of headache with IHS criteria. According to the headache with IHS criteria. According to the frequency of days with headache per month, frequency of days with headache per month, headache was classified as episodic or chronic headache was classified as episodic or chronic TTH. When the diagnosis of the type of the TTH. When the diagnosis of the type of the headache could not be made definitely, it was headache could not be made definitely, it was classified as ‘unclassified headache’.classified as ‘unclassified headache’.

Overall no =

372

Male no=156Female no=

216

Headache type .No %No %No %X2 P value .

All headaches 4211.31912.22310.60.210.64

Migraine 1721.3156.96.660.009

Propable migraine310.620.90.080.77

TTH15127.731.49.30.00

Infrequent episodicTTH642.5620.90.690.4

Frequent episodic TTH853.231.40.70.4

Propable TTH110.600.00.01.5

Mixed (mig & TTH)642.5620.90.690.4

Unclassifiable .100.010.460.01.0

)Table 1 (One – year prevalence of headache in medical students of the university

1st grade

grade

>17<-18

2nd grade

<18->19

3rd grade

<19->20

4th grade <20-

>21

5th grade

<21->22

6th grade

<22->23

X2P

No%No%No%No%No%No%

Migrain550375450.0350.0444.4120.07.820.7

TTH440125337.5233.3222.2360.02.30.8

Mixed11000112.5116.7222.2120.01.460.

unclassifiable00.000.000.000.0111.100.03.760.58

Chisquarc .28.06

P<0.001

)Table 2(Prevalence of headache among the six age groups of medical students

Total Males Females .Chisquare

No%No %No%X2PS

Frontal 1023.8421.05626.10.0010.98Ns

Vertex 24.76150.314.30.350.55Ns

Temporal 1535.7526.31043.51.330.24Ns

Orbital 511.9210.5313.00.050.81Ns

Generalized 614.3421.0528.70.480.48Ns

Occipital 49.5315.814.30.530.46Ns

X23.58

P0.61 X2= 3.58 P=0.61

)Table 3(Location of headache, comparing proportions of males and females in each sub group

1st grade 2nd grade 3rd grade .4th grade .5th grade 6th grade

>17<-18>18<-19>19<-20>20<-21>21<-22>22<-23total

No%No% No% No% No% No%No% X2 P S

occasionally 213232131.020.96NS

Once or twice

amonth

212221100.440.99NS

Once or twice aweek 522132152.650.75NS

daily10111041.280.9NS

)Table 4(Frequency of headache among the six age groups of medical students

1st grade

>17<-18

2nd grade

>18<-19

3rd grade

>19<-20

4th grade

>20<-21

5th grade

>21<-22

6th grade

>22<-23

total Chisqure

No %No %No %No %No %No %No %X2P

Frontal330125225116.7222.2120.01023.80.440.99

Vertex 11000112.500.000.000.024.82.860.7

Temporal 440250225233.3333.3240.01535.70.910.96

Orbital00125112.5116.7111.1120.0511.92.460.78

generalized 11000112.5116.7222.2120.0614.31.460.91

Occipital 11000112.5116.7111.100.049.21.910.92

)Table 5 (location of headache among the six age groups of medical students

1st Grade

>17<-18

2nd grade

>18<-19

3rd grade

>19<-20

4th grade

>20<-21

5th grade

>21<-22

6th grade

>22<-23

TotalChi square

No%No%No%No%No%No%No%X2S

Severe440250337.5233.3444.42401740.50.370.99

Moderate330250225233.3333.31201331.00.90.92

Slight1100012.5116.7111.10049.50.410.92

Varying22000225116.7111.1240819.02.940.7

)Table 6 (Degree of severity of headache the different grades of faculty of medicine .

X2=12.32P= 0.006* significant

triggering factors No%

Noise 2764.3*

Anxiety 2559.5

Sleeping disturbance2457.1

Physical activity 2252.4

Heat 2150.0

Annoyance 2150.0

Intense light 2047.6

Studying for exam1945.2

Emotion upset 1842.9

Menstruation in♀ 716.7

Eating habits 12.4

Exposure to sun:2047.6

)Table 7(Triggering factors of headache among medical students in Zagazig University

P>0.001**|

Coping strategy No of

patients

%

sought medical assistance 614.3

Self medication .1740.5*

No medication or any other coping strategy 511.9

Sleep 1228.6

Food 12.4

Cord compress 12.4

)Table 8(Coping behavior of medical students with headache

P>0.001”

Migraine Tension

Family historyNo %No %

Positive 1155.0213.3

Negative 945.01386.7

)Table 9 (Comparing of family history in migraine and tension type headache patients.

1st

grade

>17-

<18

2nd

grade

>18<-19

3rd

grade

>19<-20

4th

grade

>20-

<21

5th

grade

>21<-22

6th

grade

>22-

<23

Total Chi square

No%No%No%No%No%No%No%X2S

550250565.

5

350666.

6

2402354.

8

1.30.93N

s

Diffuse slowing11000112.

5

00111.

1

12049.51.80.87N

s

Sharp waves 11000112.

5

116.

7

111.

1

120511.

9

1.80.8Ns

Spike & slow waves 11012500116.

7

111.

1

0049.52.860.72

Sharp & spike Wave

complex

220125112.

5

116.

7

00120614.

3

2.320.8

)Table 10 (EEG changes among the six age gourps of medical students .

No of

participants

%No of

cases

%CT

findings

> 17<-184310normal

> 18<-19514normal

> 19<-20 608normal

> 20<-21556normal

> 21<-22919normal

> 22<-23725normal

total37242normal

)Table 11 (CT findings in medical students patients.

The prevalence of headache was 8.9% (42/372) among the The prevalence of headache was 8.9% (42/372) among the studied students, 7.7%had tension-type headache in males studied students, 7.7%had tension-type headache in males students where it was 1.4 % in female and 6.9% had migraine students where it was 1.4 % in female and 6.9% had migraine in females where it was 1.3 % in male. Tension-type headache in females where it was 1.3 % in male. Tension-type headache in males and migraine in females was statistically significant in males and migraine in females was statistically significant ((PP= 0.002) and. (= 0.002) and. (PP= 0.009) respectively. The site of headache = 0.009) respectively. The site of headache (temporal 35.7% , frontal 23.8%, generalized 14.3% orbital (temporal 35.7% , frontal 23.8%, generalized 14.3% orbital 11.9% and vertex 4.76%) , characters ( throbbing/pulsating 11.9% and vertex 4.76%) , characters ( throbbing/pulsating 42.9%, tightness/pressure 33.3% stabbing/sharp16.7% and 42.9%, tightness/pressure 33.3% stabbing/sharp16.7% and do not know 7.1%) and frequency ( once or twice a week do not know 7.1%) and frequency ( once or twice a week 35.7%,occasionally 30.95%, once or twice a month 23.8% and 35.7%,occasionally 30.95%, once or twice a month 23.8% and daily 9.5%) were statistically insignificant between male and daily 9.5%) were statistically insignificant between male and females and all age groups, but positive family history of females and all age groups, but positive family history of headache (father, mother, sons, second degree relatives) had a headache (father, mother, sons, second degree relatives) had a statistically significant effect on the presence of headache in statistically significant effect on the presence of headache in students.students.

headache is a prevalent symptom in the college headache is a prevalent symptom in the college age population. Further research is needed to age population. Further research is needed to determine the prevalence of specific types of determine the prevalence of specific types of headache. Healthcare providers should headache. Healthcare providers should educate this population as well as assist educate this population as well as assist students in properly diagnosing and treating students in properly diagnosing and treating headache types. The evident burden of headache types. The evident burden of headache disorders on individuals and on headache disorders on individuals and on society is sufficient to justify a strategic society is sufficient to justify a strategic change in the approach to headache change in the approach to headache management.management.