Discussion
Headaches are prevalent neurological illnesses that exert a substantial impact on both the individual experiencing them and the surrounding community, significantly impeding daily functioning, particularly when concomitant symptoms are present.15 Multiple triggers may have a potential role in provocation of headache attacks. Those triggers include diet,16 environmental factors,17 physiological factors like menstruation18 or psychological factors like stress and sleep abnormalities.19
Stress has been identified as a significant precipitant of headache attacks. It could exacerbate heightened pain sensitivity in individuals with chronic headache conditions, hence further decreasing the threshold for perceiving noxious stimuli originating from structures around the head.20 Rapid environmental shifts are a major cause of stress in modern life. The student age is sometimes referred to as the ‘age of stress’ due to the heightened pressures placed on students in today’s competitive society. Academic tests, assignments, attendance and other university requirements put students under a lot of stress that they are nt always able to handle.21
In this study, we performed a multicentric, descriptive questionnaire-based cross-sectional study among undergraduate medical students. Undergraduate students enrolled in medical colleges are currently encountering a novel phase characterised by transformative educational experiences, heightened psychological strain and cognitive advancements. This phenomenon gives rise to a connection between pain and unpleasant emotions, which can be influenced by neurocognitive mechanisms. An individual’s self-efficacy, or their belief in their own capability to execute the steps required to achieve a desired goal within various contexts, has the potential to mitigate both headaches and the adverse impacts of stress on their well-being.22 23 In our study, the prevalence of headaches among participants was common and estimated about 53.5%. Our results are close to the results of other studies done among undergraduate students in Iran, Oman and India.8 24 25 In contrast, studies conducted in Nigeria and Nepal26 27 reported lower prevalence rates. Several factors can account for the disparity between our study’s findings and those mentioned studies on headache prevalence. Variations in research methodologies, the use of self-reporting questionnaires, and the study durations differed across studies. For instance, Ojini et al26 focused on the 1-year prevalence of headaches, whereas our study assessed prevalence over the past 3 months. Additionally, studies conducted during stressful periods such as midterms, end of clinical rounds or final exams were anticipated to report higher headache prevalence. Furthermore, racial differences, nutritional habits and variations in weather and climate are also likely contribute to the observed differences in prevalence rates.28
In our study, we noticed that there was a significant relation between the sex of the participants and headache occurrence with predominant female participants. These results were consistent with other studies, which also had a female predominance.8 13 24 25 However, this disagrees with other studies that had a male predominance.10 27 Recent data suggest that women are more affected by headaches than men. This is attributed to the influence of fluctuations in ovarian steroid hormones, particularly oestrogen and progesterone, on headache occurrence.29 30
In addition to that, our study showed significant relations between the academic year and headache prevalence. The most prevalent headache group was in the third academic year. This can be attributed to the fact that the third year represents a transitional phase for students moving from preclinical to clinical studies. This shift introduces new learning environments, clinical responsibilities and practical exams, which can be stressful and potentially contribute to a higher incidence of headaches.31 Those results were opposed by the data of a previous study done by Bhattarai and his colleagues,27 which showed a lower prevalence of headache in the third-year MBBS students compared with other academic years.
There was no apparent association between smoking and headaches in our study (p value=0.4). The relationship between headaches and smoking is controversial. Some studies do not support that there is a strong causal relationship between smoking intensity and any type of headache.32 33 Other studies showed that previous smoking was associated with an increased risk of migraines, but not TTH.34 One meta-analysis reported that there was conflicting data supporting the validity of patient-reported environmental tobacco exposure as a headache trigger.35
Most of the participants in our study suffered from TTH frequent episodic and TTH infrequent episodic, followed by migraine with or without aura, and then TTH chronic. This can be explained as TTH represents a very common type of headache among adolescents.36 Approximately 15%–20% of population-based studies identify this type of headache as being the most neglected.21 Among medical students, this might be due to the long working hours, which lead to fatigue, stress and anxiety. Students with frequent headaches mostly suffer from lost study days, which lead to reduced academic performance, poor concentration, and poor attitudes and behaviour.37
Students with different types of headaches reported that headache interfered with their daily life activities. This result was consistent with previous studies which explained that headaches affected daily functions and activities.11 27 Also, headaches are major problems, which cause absence from work, physical labour, lack of decision-making skills and memory.38
Among different types of headaches, we found that family history is the more potent and consistent risk factor for migraines than other types. This could be supported by a study by Hernández Latorre et al that revealed relatives of people with migraines are two-to-three-fold greater risk of migraines compared with controls.39
Strengths and limitations
Our study is one of the pioneers’ studies using the multistage random methodology to represent the prevalence of headaches among medical students. It builds on prior research conducted by Oraby et al11 to assess migraine prevalence among the same population, However, it is a single-centre study that cannot be generalised among all medical students in Egypt. In addition to that, the diagnosis of headache in our study is based on the criteria of ICHD-III for the most accurate diagnosis. However, the study also has notable limitations. There was a high risk of recall bias, resulting from using self-reported questionnaires. Additionally, the survey used was not validated, which may affect the reliability and accuracy of the reported data. Although we followed ICHD-III criteria for diagnosing headaches, we did not confirm diagnoses through clinical assessments or objective measures. Furthermore, we did not use strict criteria to diagnose psychological triggers of headache such as anxiety and depression, instead of participants’ self-reports. So, we suggest conducting more longitudinal research to study the cause-and-effect relationship among headaches and different variables.