Prevalence Of Headache Among Medical Student

Background

: Headache is one of the most common complaints during the medical curriculum and occurs due to numerous psychological and physical stressors, which are more prevalent among medical students than in the general population. This study aimed to evaluate the frequency, characteristics, and types of headaches, as well as their precipitating and associated variables among medical students. Aim: Headache is among the commonest complaints in medical students it could be due to many physical or psychological stressors The aim of this study is to assess the prevalence of headache among male and female medical students Methods: This cross-sectional study was conducted at Al-Ameed University Faculty of Medicine and Kerbala University Faculty of Medicine from October 2023 to February 2025.

First- to sixth-year medical students who had experienced some form of headache in their lifetime and had headache attacks during the past 6 months were included. All participants completed a structured checklist covering demographic data, associated factors, and headache characteristics. Medical stages were classified into three groups: Group 1 (first and second years), Group 2 (third and fourth years), and Group 3 (fifth and sixth years) to assess significant differences in headache characteristics among them. Results: A total of 624 students from two medical colleges in Kerbala province, Iraq, were included: 298 males (47.8%) and 326 females (52.2%). Overall, 47.5% of students reported headaches starting after an accident, illness, or infection, suggesting potential external triggers (26% males, 39.5% females).

The majority of headaches were subacute (44.2%), lasting 4–8 weeks, while 42.6% were acute (<4 weeks). Chronic headaches (>3 months) were less common (13.2%). The most common precipitating factor was stress and anxiety (55.9%), followed by fatigue (55.1%) and loud noises (47.4%). No significant relationship was found between headache and foods or medications. Headache was most frequently described as tightness (49%) or throbbing (30.9%). Notably, neuroimaging was performed in 37.1% of patients without clear indications. Several headache characteristics were significantly associated with all stages of study, while others were significantly associated with gender. Conclusion: Headache is very common among medical students, with a prevalence exceeding 50%. Most headaches fall into the subacute category and do not require neuroimaging or extensive investigations.

The most striking findings were stress, anxiety, and fatigue as precipitating factors. Furthermore, certain headache characteristics are significantly associated with the level of stress across all study stages. Females were more susceptible to headache, with significant associations between many headache characteristics and gender across different stages of study. We recommend providing mentor educators for all students and establishing a center to address mental, social, and medical issues for all students in medical colleges, given the high burden of stress and long study hours that accompany this burden. Keywords: Headache, stress, anxiety, medical students, prevalence.

Introduction

Headache is a subjective sensation of pain or discomfort of the head or face, often triggered by stress, dehydration, sleep deprivation, or underlying medical conditions ^[1]. Headache disorders are among the most prevalent neurological conditions; 50% of adults experience at least one headache per year, with higher occurrence in women ^[1]. Primary headaches (migraine, tension-type headache, cluster headache) account for nearly 98% of cases, while secondary headaches may indicate serious pathology ^[1]. The International Classification of Headache Disorders, 3rd edition (ICHD-3) provides standardized diagnostic criteria ^[2]. Key red flags for secondary headache are summarized by the mnemonic SNOOPP (Systemic symptoms, Neurologic deficits, Sudden onset, older age, Progressive course, Positional change/ Precipitators/Papilledema) [3–5].

Management includes trigger avoidance, acute analgesia (paracetamol, NSAIDs), and prophylaxis for frequent attacks (≥2/month) with betablockers, amitriptyline, or topiramate ^[1]. Headache is a common complaint among medical students due to physical and psychological stressors ^[6]. This study aims to assess the prevalence of headache among male and female medical students. Aim of the study Headache is among the commonest complaints in medical students it could be due to many physical or psychological stressors The aim of this study is to assess the prevalence of headache among male and female medical students.

Methodology

Study design and setting A cross-sectional study was conducted from October 2023 to February 2025 among undergraduate medical students at two colleges in Kerbala province, Iraq: University of Al-Ameed Faculty of Medicine (minimum 50 students per stage, years 2–6) and University of Kerbala Faculty of Medicine (minimum 20 students per stage, years 1–6), representing diverse socioeconomic backgrounds. The cross-sectional design is appropriate for assessing the prevalence of conditions such as headache in a defined population at a single time point ^[7,8]. Sampling A stratified random sampling technique was employed using academic year as the stratum. Stratified random sampling ensures representation from each subgroup (academic year) and improves the precision of prevalence estimates compared to simple random sampling ^[9,10].

The total sample size was proportionally allocated to each year (first to sixth), followed by simple random sampling using random number generator software. The response rate was 100%. Stress classification Medical stages were categorized by stress level: mild (years 1–2), moderate (years 3–4), and severe (years 5–6). Previous studies have demonstrated that psychological stress levels vary significantly across different phases of medical education, with earlier and later years often showing higher distress ^{[11, 12]}. Statistical analysis Data were entered into a spreadsheet and analyzed using SPSS version 28.0 (IBM, Chicago, Illinois, USA) ^[13,14] and Real Statistics Resource Pack for Excel 2016. Descriptive statistics were presented as n (%) for categorical variables and mean ± standarddeviation(SD)forcontinuousvariables^[15].Normality was assessed using the Shapiro-Wilk test ^[16].

Homogeneity of variances was assessed by Levene's test (p < 0.05). Fisher's LSD method was used for confidence intervals. A p-value < 0.05 (two-sided) was considered statistically significant.

Results

Demographic and clinical characteristics This study investigated the characteristics of headaches among medical students. Nearly half (47.5%) of students reported headaches starting after a participating factor (smoking, sleeping prevention, fatigue). Most headaches were described as episodic (72.6%) rather than constant (27.4%). Weekly headaches were the most frequent (45.0%), followed by monthly (31.8%) and daily (23.1%). And the rest of result shown in the table below. The perveance of headache is (53%) Table 1. Characteristic of headache among medical students(N=624). Variable G Frequency Percentage Did the headaches start after participating factors (smoking, sleeping prevention, fatigue) Yes 296 47.5 No 328 52.6 The headaches Are constant 171 27.4 Come and go 453 72.6 How often do the headaches occur?

Daily 144 23.1 Weekly 281 45.0 Monthly 199 31.8 How many hours do the headaches last? 1-6 373 59.8 6-12 170 27.2 12-24 65 10.4 12-48 11 1.8 48-72 3 .5 More than 72 2 .3 Do the headaches occur at a certain time of day? Morning 155 24.8 Afternoon 294 47.1 Night 175 28.1 Are the headaches becoming: Stronger 156 25.0 Lasting longer 151 24.2 Occurring more frequently 140 22.4 None 177 28.4 Do the headaches ever wake the patient up when they are asleep? Yes 189 30.3 No 435 69.8 Does rest or sleep relieve the headache? Yes 397 63.6 No 227 36.4 Do the headaches stop the patient from doing regular daily activities?

Yes 299 47.9 No 325 52.1 Has the patient ever missed work/school because of a headache? Yes 247 39.6 No 377 60.4 Table (2) demonstrated that the most concerning finding is that anxiety or stress was the overwhelming leader, with over (55.9%) of students followed by fatigue (55.1%) and loud noises (47.4%) the rest of result shown in the table below. Table 2. Frequency of the most common participating factors of headache among medical students(N=624). Variable Frequency Percentage Anxiety or stress 349 55.9 Fatigue 344 55.1 Loud Noises 296 47.4 School 278 44.6 Family problems 262 42.0 Hunger (missing meals 253 40.5 Too little sleep (staying up late) 241 38.6 Too much sleep (sleeping in) 224 35.9 Bright lights 209 33.5 Sunshine 206 33.0 Odors (Perfume, cigarettes) No.

201 32.2 Hot weather 200 32.1 Ice cream 186 29.8 Menstrual cycle 183 29.3 Riding in a car 166 26.6 Exercise or playing 157 25.2 Birth control pills 135 21.6 Alcohol 96 15.4 Figure 1. Frequency of the most common participating factors of headache among medical students(N=264). Table (3) shows the frequency of various factors that may contribute to headaches among medical students. Table 3. Association of medications, foods and headache frequency(N=624). Variable Groups Frequency Percentage Pvalue Medication Yes 131 21 No 493 79.0 Certain foods Yes 90 14.4 No 534 85.6 Table (4) illustrated the frequency of various warning signs reported by medical students before experiencing headache, it was reported that Tiredness, sleepiness, or yawning were the most common warning sign (50.5%).

(43.4%) of students reported experiencing dizziness before headaches. Eye problems, Over (42.5%) of the students reported eye problems as a warning sign. Other warning signs like paleness, mood swings, increased appetite, and cravings were reported by less than half of the students and the rest of result shown in the table below. Table 4. Frequency of the warning signs BEFORE the headache begins among medical students(N=624). Variable Frequency Percentage Tired, sleepy or yawning 315 50.5 Dizziness 271 43.4 Eye problems 265 42.5 Mood swings (either high or low) 247 39.6 Irritability 210 33.7 Rings around the eyes 182 29.2 Craving sweets 147 23.6 Increased appetite 144 23.1 Paleness 140 22.4 Hyperactivity 136 21.8 Figure 2.

Frequency of the warning signs BEFORE the headache begins among medical students(N=624). Table (5) below shows the frequency of headaches in various locations among medical students. Forehead headaches are the most common (43.9%) followed by all around the head (38%) and left-sided headaches (28.5%) . Neck, right-sided, top of head, temple, and back of head headaches are all less frequent and the rest of result shown in the table below. Table 5. Frequency of the headache locations among medical students(N=264). Variable Frequency Percentage Forehead 274 43.9 All around the head 237 38.0 Left side 178 28.5 Back of the head 170 27.2 Neck 160 25.6 Right side 143 22.9 Top of the head 143 22.9 Temples 141 22.6 Figure 3.

Frequency of the headache locations among medical students(N=264). Table (6) shows the frequency of different types of feelings reported by medical students. Results demonstrated that various sensations experience, including pressure, sharpness, tightness, throbbing/pounding, aching, and dullness. Tightness (like a rubber band wrapped around the head) was the most common feeling (49%). Throbbing pain, a hallmark of migraine headaches, were also common (30.93%). aching pain and dull pain were all less frequent. The rest of result shown in the table below. Table 6. characteristic of headache among medical students(N=624). Variable Frequency Percentage Ice back pain 160 25.6% Throbbing/pounding (like a hammer) 193 30.9% Tightness (like a rubber band wrapped around the head) 306 49% Dull 148 23.7% Figure 4.

characteristic of headache among medical students (N=624). Table (7) Presented the frequency of various symptoms experienced by medical students during headaches. Nausea is the most common symptom (39.7%), followed by confusion (33%). Vomiting was less frequent than others (26.1%). The rest of result shown in the table below. Table 7. Frequency of the symptoms when the patient has a headache among medical students(N=624). Variable Frequency Percentage Nausea 248 39.7 Dizziness and light headedness 206 33.0 Fatigue in the arms or legs 164 26.3 Vomiting 163 26.1 Stomach pains 142 22.8 Numbness to the arms and face 118 18.9 Figure 5. Frequency of the symptoms when the patient has a headache among medical students(N=624).

Table (8) shown the frequency of various tests performed during headache treatment among medical students. Blood tests (44.23%) were the most commonly performed test, followed by eye exams (35.89%), followed by dental exam (20.8%) the rest was less common and as it shown in the table below. Table 8. Frequency of the test performed during that headache treatment period among medical students(N=624). Variable Frequency Percentage Blood tests 276 44.2 Eye exam 225 36.1 Dental exam 130 20.8 Sinus X-rays 130 20.8 Allergy tests 121 19.4 CT Scan 117 18.8 MRI 114 18.3 Figure 6. Frequency of the test performed during that headache treatment period among medical students(N=624). Table (9) shown the Association between characteristic of headache and medical stage and show that the frequency of headache was common weekly in moderate stress stages (18%) followed by severe stress stages (17.7%) and mild stress stages were less common.

The duration most common between 1-6 hours in severe stress stages (26.6%) followed by moderate stages (21.96%) and less common in mild stress stages. The rest of the result shown in the table below. Table 9. Association between characteristic of headache and medical stage (N=624). Variables Groups Stress stages P value Mild Moderate Severe University University of Al-Ameed 100 200 150 0.001[S] 21 53 100 The headaches constant 44 75 50 0.003[S] episodic 77 178 200 Frequency of the headache Daily 44 52 48 0.001[S] Weekly 51 116 114 Monthly 26 85 88 How many hours do the headaches attack last? 1-6 61 141 171 <0.001[S] 6-12 37 82 51 12-24 22 21 22 12-48 1 7 3 48-72 0 1 2 More than 72 0 1 1 Stronger 48 52 56 The headache pattern Lasting longer 44 62 45 0.04[S] Occurring more frequently 14 59 67 None 15 80 82 headaches ever wake the patient up when asleep?

Yes 50 86 53 0.001[S] No 71 167 197 Does rest or sleep relieve the headache Yes 69 139 189 0.003[S] No 52 114 61 Headaches stop the patient from doing regular daily activities Yes 61 112 126 0.002[S] No 60 141 124 Patient ever missed work because of a headache Yes 59 102 86 0.021[S] No 62 151 164 Starts out small & builds up 67 154 161 Chi-Square Results are presented as N(%), p<0.05 considered significantly different, [S]= Significant, [NS]= Non-significant Table (10) shown Association between characteristic of headache and Sex. It shows that the headache was most common in male who experienced headaches without participating factors (28.19%) and more frequent in females that triggered by participating factors (27.7%).The headaches tend to be more subacute (24.29%) than acute (22.1%) in females while it was acute (19.3%) than subacute (18.69%) in males.

The rest of the result shown in the table below. Table 10. Association between characteristic of headache and Sex(N=624). Variables Groups Sex P value Male Female University University of Al-Ameed 224 226 0.432 [NS] University of Kerbala 74 100 Did the headaches start after participating factors (smoking, sleeping prevention, fatigue) Yes 117 178 0.002 [S] No 181 148 How long has the patient had these headaches Acute 124 142 0.004 [S] Sub-Acute 120 156 Chronic 54 28 The headaches constant 55 114 0.021 [S] Come & go 243 212 How often do the headaches occur Daily 53 91 0.001 [S] Weekly 139 142 Monthly 106 93 How many hours do the headaches last?

1-6 197 176 <0.001 [S] 6-12 60 110 12-24 35 30 12-48 2 9 48-72 2 1 More than 72 2 0 Do the headaches occur at a certain time of day day 62 93 <0.001 [S] Morning 134 160 Afternoon 80 62 Night 22 11 Are the headaches becoming Stronger 67 89 <0.001 [S] Lasting longer 55 96 Occurring more frequently 83 57 None 93 84 Do the headaches ever wake the patient up when they are asleep? Yes 75 114 0.003 [S] No 223 212 Does rest or sleep relieve the headache Yes 200 197 0.543 [NS] No 98 129 Do the headaches stop the patient from doing regular daily activities Yes 147 152 0.054 [NS] No 151 174 Has the patient ever missed work/school because of a headache Yes 116 131 0.322 [NS] No 182 195 Is the headache pain Intense when it starts 112 124 0.521 [NS] Starts out small and builds up 186 202 Chi-Square Results are presented as N(%), p<0.05 considered significantly different, [S]= Significant, [NS]= Non significant Table (11) shown Association between characteristic of headache between medical stage and sex it shows that the duration of headache mostly acute in moderate stress stages in males (18.79%) and was mostly subacute in moderate stress stages in female (22.08%) and the rest of result shown in the table below.

Table 11. Association between characteristic of headache between medical stage and sex (N=624) Variable Groups Male N=298 P value Female N=326 P value Mild stress Moderate stress Severe stress Mild stress Moderate stress Severe stress How long has the patient had these headaches Acute 14 56 54 0.001 [S] 0.002 [S] 29 55 58 0.002 Sub Acute 25 40 55 29 72 55 Chronic 18 20 16 6 10 12 How many hours do the headaches last? 1-6 29 88 80 0.067 [NS] 0.05 [S] 41 55 80 0.05 6-12 20 18 22 20 45 45 12-24 5 21 9 6 13 11 12-48 0 2 0 0 9 48-72 0 0 2 0 1 0 More than 0 1 1 0 0 0 Dose the headache awakes the patient from sleep Yes 23 22 30 0.001 [S] 32 34 48 0.002 [S] No 38 89 96 28 108 76 Does rest or sleep relieve the headache Yes 32 76 92 0.001 [S] 32 90 75 0.003 [S] No 20 38 40 37 49 43

Discussion

The present study demonstrates that headache is a highly prevalent condition among medical students, with an overall prevalence of 53%. This finding is consistent with previous studies reporting prevalence rates ranging from approximately 50% to over 70% among medical students, reflecting the significant burden of headache disorders in this population ^[17,18]. For instance, a study conducted among medical students reported a headache prevalence of 68%, highlighting the widespread nature of this condition ^[19]. A considerable proportion of participants (47.5%) reported that their headaches were triggered by identifiable factors such as smoking, sleep deprivation, and fatigue. These findings are in agreement with previous research indicating that lifestyle-related factors, particularly poor sleep hygiene and stress, play a major role in headache occurrence ^[20,21].

Moreover, the predominance of episodic headaches (72.6%) suggests that most cases are likely primary headaches, particularly tension-type headaches (TTH) and migraines, which are the most common subtypes reported in similar populations ^[22,23]. Regarding headache frequency, weekly episodes (45%) were the most commonly reported pattern. Comparable findings have been reported in earlier studies, where recurrent headaches were attributed to ongoing academic stress and irregular daily routines among medical students ^{[24, 25]}. The majority of headaches in this study lasted 1–6 hours (59.8%), which is consistent with the typical duration of primary headaches, particularly migraines and TTH, as defined by international classification criteria ^[26]. The temporal distribution showed that headaches occurred most frequently in the afternoon (47.1%), likely reflecting cumulative fatigue and prolonged cognitive effort throughout the day.

This observation is supported by evidence linking prolonged mental activity and inadequate rest to increased headache risk ^[27,28]. Furthermore, the fact that 63.6% of participants reported relief with rest or sleep reinforces the role of fatigue and sleep disturbances in headache pathogenesis ^[29]. The functional burden of headaches was considerable, with 47.9% of students reporting interference with daily activities and 39.6% missing academic activities. These findings are consistent with previous studies demonstrating that headaches significantly impair academic performance and quality of life, with many students reporting reduced productivity and absenteeism ^[30,31]. Among the triggering factors, stress and anxiety (55.9%) were the most prominent, followed by fatigue and environmental stimuli such as loud noise.

This aligns with a large body of literature identifying stress as a key precipitating factor for both migraine and tension-type headaches in student populations ^[32,33]. Academic-related stressors, particularly examinations, have been shown to significantly increase headache frequency and severity ^[34]. Prodromal symptoms were commonly reported, with tiredness, sleepiness, or yawning (50.5%) being the most frequent. Such symptoms are well-documented in migraine patients and are considered early indicators of impending headache attacks ^[35,36]. Additional symptoms such as dizziness and visual disturbances further support the presence of migraine features among a substantial proportion of participants. In terms of headache characteristics, the forehead (43.9%) was the most common location, while tightness (49%) was the most frequently described sensation, consistent with tension-type headaches.

However, the presence of throbbing pain (30.9%) and associated symptoms such as nausea (39.7%) suggests a significant overlap with migraine-type headaches. Previous studies have similarly reported coexistence of tension-type and migraine headaches among medical students ^[37,38]. Regarding diagnostic evaluation, blood tests (44.2%) and eye examinations (36.1%) were the most commonly performed investigations, while advanced imaging modalities such as CT and MRI were less frequently utilized. This is consistent with clinical practice, where imaging is generally reserved for cases with suspected secondary causes rather than routine evaluation of primary headaches ^[39,40]. Statistically significant associations were observed between headache characteristics and stress levels, with increased stress correlating with higher frequency and longer duration of headaches.

This finding is supported by previous studies demonstrating a strong relationship between psychological stress and headache severity in students ^[41,42]. Additionally, gender differences were observed, with females more likely to experience headaches triggered by external factors and of longer duration. This is consistent with prior research showing a higher prevalence of migraine among females, potentially due to hormonal and psychosocial influences ^[43,44]. In conclusion, the findings of this study indicate that headaches among medical students are highly prevalent and multifactorial, with significant contributions from stress, lifestyle factors, and environmental triggers. The substantial impact on academic performance and daily functioning highlights the need for targeted interventions, including stress management programs, improved sleep hygiene, and increased awareness of headache triggers.

Future studies should focus on longitudinal designs and interventionbased strategies to reduce the burden of headaches in this vulnerable population ^[45,46].

Conclusion

Headache is highly prevalent among medical students, affecting over half of the study population. Most headaches were episodic, commonly occurring on a weekly basis, and typically lasted 1–6 hours. Stress, fatigue, and sleep disturbances were the main contributing factors, with stress being the most significant trigger. The clinical profile suggests a predominance of tension-type headaches, although migraine features were also observed. Headaches had a notable impact on daily activities and academic performance. Significant associations with stress levels and gender differences highlight the multifactorial nature of headache in this population. Recommendations Implementation of stress management programs and promotion of healthy sleep habits are strongly recommended. Universities should encourage lifestyle modifications, including regular physical activity and balanced nutrition, while improving access to medical care for early diagnosis and management.

Additionally, optimizing academic workload and increasing awareness about headache triggers and self-management strategies may help reduce the burden. Further longitudinal and interventional studies are recommended to better understand and address this issue. Acknowledgement Authors like to think University of Al-Ameed for the partial support Conflict of interest none Funding Nil Author contribution Equily contributed

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