Health Project

Awareness Campaign of the Effects of Migraine in College Students

Applied Psychology

Submitted To

Ms. Mamoona Rameesa

Submitted by

Laiba Sarfaraz 011621025

Arfa Iqbal 0011621007

Kainat khan 011621021

Sumaiya Shahid 011621043

Wajiha Yameen 011621046

Areeba Iqbal 011621006

Department of Applied Psychology

Govt. Postgraduate College (W), Gulberg Lahore

 Acknowledgement

Firstly, I would like to thank Allah Almighty for giving me strength, knowledge, ability

and opportunity to complete my internship. He was the one who taught me, guided me and

inspired me throughout my life. Without his blessing this achievement would not be possible.

I am thankful to my parents for their prayers and I am thankful to my friends for their support

and help in my work. I am obliged to thanks my family and friends whose support and

encouragement was of crucial importance to me all the times.

I am also thankful to Ma’am Naveed Anjum, Head of Department, for providing

such an excellent opportunity to conduct this project. Words are insufficient to express my

deepest gratitude to our respected teacher and supervisor, Ma’am Mamoona Rameesa,

Department of Applied Psychology, Government Postgraduate College for Women Gulberg,

Lahore, Pakistan for her continuous guidance, encouragement and support her cooperation,

and to be always there to answer my queries throughout the process report writing of our

project work.

Thank you everyone!

 Table of content

Sr. no. Title Page no.

1. Introduction 01

2. Methodology 11

3. Discussion 14

4. References 18

5. Appendix A

6. Appendix B
 1

Chapter I

Introduction

Health psychology is a specialty area of psychology that focuses on how all facets of

our lives impact our physical health. Psychologists in this field don't treat the disease itself,

but try to find ways to help the person who is suffering improve his or her life by better

understanding how the mind and body work together. Health psychologists provide a non-

traditional approach to understanding our health. One purpose of this field is to inform and

educate people, helping them understand that they can take control of their overall well-

being. When patients understand how and why their bodies are responding to physical

problems, they are better able to accept solutions. Health psychologists can help patients

manage chronic conditions or help them find ways to avoid preventable diseases by living a

healthy lifestyle. Ideally, health psychology is where medicine is to mediate the relationship

between disease, thought and behaviour.

Health psychology focuses on how biology, psychology, behaviour, and social factors

influence health and well-being. Health related projects help people to understand their

problems, find out strategies that result in better long-term outcomes, prevalence and the

factors contributing to individual experiences, mental health interventions which are most

effective in treating the disorder, evaluation of how stress management techniques and

relaxation methods can be helpful for patients suffering from chronic pain, to determine how

effective are the tactics, comparing and contrasting different approaches to problems for

cessation, to see which strategies are the most effective (Cherry, 2018).

Health psychologists apply their expertise in many settings, including private

practices, hospitals and primary care programs, universities, corporations, government

agencies and specialty practices, such as oncology, pain management, rehabilitation and

smoking cessation.
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Helping people make choices that have a positive impact on their health — and the

well-being of their families, the workforce and their communities is at the heart of this

dynamic field (APA).

The goals of health projects are to apply health education, information, prevention,

and control in ways that will alleviate sufferers' physical symptoms and improve their lives.

The main approach used to set goals in health psychology is the biosocial model. Health

psychology can be defined as the application of psychological knowledge and methods to the

study, prevention, and management of physical diseases and disorders. (Smith, 2001)

Evident in this definition is the fact that health psychology is both a science and an

applied discipline intended to promote human welfare. However, unlike many psychological

disciplines, health psychology addresses issues of physical rather than mental health.

Emotional adaptation and mental health are considered in health psychology only to the

extent that they influence or are influenced by physical health and illness (Schwarzer and

Gutiérrez, 2000).

Health psychology measurement is undertaken in order to understand behavioural and

psychological processes in health, illness, and health care. The purpose may be research or

application, especially in the fields of public health or clinical medicine. Measures are used

to address three mains theoretically, based questions concerning:

(i) The assessment of psychological and behavioural indices of the status or amount

of health, illness, or health care;

(ii) The assessment or evaluation of the psychological and behavioural consequences

of health, illness, or health care;

(iii) The assessment of psychological and behavioural factors as predictors or

explanations of health, illness, or health care.

 3

Migraine is a common neurological disorder that is caused by the stimulation of a

mechanism in the brain that leads to release of pain-producing inflammatory substances

around the nerves and blood vessels of the head. This disorder usually begins at puberty and

mostly affects people aged from 35 to 45 years. Migraine headaches are more common in

women, with a ratio of 2:1, due to hormonal factors (World Health Organization, 2016.)

“Migraine is ranked among the world’s leading causes of years lived with disability”

(Frederick et al., 2014). Headache disorders tend to occur in about 50% among adults

worldwide. Of those 50% of people with headache disorder, 30% or more have reported

migraine (World Health Organization, 2016).

According to the Migraine Research Foundation (MRF), “Migraine is an extremely

incapacitating collection of neurological symptoms. Everyone either knows someone who

suffers from migraine or struggles with migraine themselves.”

The Mayo Clinic says that several factors may contribute to the likelihood of having

migraines, including family history, age, gender, lifestyle, and hormonal changes.

When it comes to migraines, many things are known. There is a long list of potential

triggers, from specific foods to hormones. Migraines affect the body in different ways.

Genetics or environmental factors may come into play.

Research plays a critical role in all of these aspects. Scientific studies can help

identify triggers, gain increased understanding of what happens in the brain and body during

the migraine and get clues to treatments or even a cure. Different studies focus on specific

aspects of cause and effect. This research is critical to making progress in the fight to treat or

even eliminate migraines. Migraine is a common brain disorder with high disability rates

which involves a series of abnormal neuronal networks, interacting at different levels of the

central and peripheral nervous system.

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Our project aims to find out its awareness among university students and

professionals and also to check its prevalence in them. The common causes of migraine in

university students and professionals are considered to be as stress, tension, sleep disturbance

and work load. So, as to identify and raise awareness of what it is to suffer from migraines

from students' perspectives, the subject is taken up, in order to improve the management of

migraine. The project focuses on understanding and/or changing behaviour in the context of

health, illness or healthcare.

Migraine is classified into Migraine without aura and Migraine with aura. Migraine

with aura has several sub-classes including Migraine without headache, Migraine with

brainstem aura, Hemiplegic migraine, Retinal migraine and Chronic migraine

Migraine without aura (formally called common migraine) is the most frequent type

of migraine. Its symptoms include moderate to severe pulsating headache (comes with

nausea and/or vomiting, photophobia and phonophobia) that is aggravated with movement. A

prodromal phase (warning phase) may occur hours or days before the headache. Its

symptoms may carry on into the headache phase. Along with the nausea, vomiting and

sensitivity to stimuli. The common warning symptoms include cognitive dysfunction, blurred

vision, mood changes, fatigue, food cravings, yawing, neck stiffening and pain. These may

also be in migraine with aura. The headache phase may be followed by a postdrome phase

with symptoms include feeling tired or washed out and cognitive impairment.

Migraine with aura (formally called classic or complicated migraine) the type of

migraine includes visual disturbances and other neurological symptoms that appear 10 to 60

minutes before the actual headache and last nearly an hour. You may temporarily lose part or

all of your vision. The aura may occur without headache pain, which can strike at any time.

Visual aura is the most common, featuring a zigzag figure. Less frequent aura symptoms

include an abnormal sensation, numbness on one side of the body, a tingling sensation in the
 5

hands or face, trouble speaking and confusion. Many patients who have migraine with aura

attacks also migraine without aura attacks and tension-type headaches, so it is possible for

migraine case not to fit neatly in one “type”.

Migraine without headache is the typical aura without headache. It is characterized by

visual problems or other aura symptoms, nausea, vomiting and constipation but without

headache. Headache specialist suggest that fever, dizziness and unexplained pain in a

particular part of the body could also be possible types of headache-free migraine. It is

different from the complications known as abdominal migraine cyclical vomiting syndrome,

which often occur in children.

Migraine with brainstem aura (formally called basilar-type migraine) mainly affecting

children and adolescents, this type includes migraine with aura symptoms that originate from

the brainstem, but without motor weakness. It occurs most often in teenage girls and may be

associated with their menstrual cycle. Symptoms include partial or total loss of vision or

double vision, dizziness and lose of balance, poor muscle coordination, slurred speech, a

ringing in the ears and fainting. The throbbing pain may come suddenly and is left on both

sides of occipital.

Hemiplegic migraine is a rare but severe form of migraine that causes temporary

paralysis, sometimes lasting several days on one side of the body prior to or during a

headache. Symptoms such as vertigo, a pricking or stabbing sensation, problem seeing,

speaking or swallowing may begin prior to the headache pain and usually stop shortly

thereafter. When it runs families, it is called familial hemiplegic migraine (FHM). Though

rare, at least its three distinct genetic forms have been identified. These genetic mutations

make the brain more sensitive or excitable, most likely by increasing brain levels of a

chemical called glutamate.

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Retinal migraine is a very rare type characterized by attacks of visual loss or

disturbances in one eye. These attacks, like more common visual auras, are usually

associated with headache.

Chronic migraine Characterized by 15 or more headache days per month for more

than 3 months. Headache may be Migraine-like or Tension-type but has the features of

Migraine on at least 8 days per month. Attacks can be with or without aura, and they usually

require preventative medications and behaviors to control. Chronic Migraine is often

disabling. After drug withdrawal, about half of Chronic Migraine patents revert to episodic

migraine and half do not.

Causes of migraine

The cause of migraines is not yet known. It is suspected that they result from

abnormal activity in the brain. This can affect the way nerves communicate as well as the

chemicals and blood vessels in the brain.

Migraine is associated with enhanced perception and altered cerebral processing of

sensory stimuli. More recently, it has been suggested that this sensory hypersensitivity might

reflect a more general enhanced response to aversive emotional stimuli. Using functional

magnetic resonance imaging and emotional face stimuli (fearful, happy and sad faces), we

compared whole-brain activation between 41 migraine patients without aura in interictal

period and 49 healthy controls. Migraine patients showed increased neural activation to

fearful faces compared to neutral faces in the right middle frontal gyrus and frontal pole

relative to healthy controls. We also found that higher attack frequency in migraine patients

was related to increased activation mainly in the right primary somatosensory cortex

(corresponding to the face area) to fearful expressions and in the right dorsal striatal regions

to happy faces. This research showed that the migraine is related to hyper sensitivity.

Genetics may make someone more sensitive to the triggers that can cause migraines.
 7

However, the following triggers are likely to set off migraines are Hormonal changes

in women may experience migraine symptoms during menstruation, due to changing

hormone levels. emotional triggers can be Stress, depression, anxiety, excitement, and shock

can trigger a migraine.

This study investigated the intensity of stress, anxiety and depression in a sample of

141 migraines compared with a control group of 109 non-migraine workers matched for age

and sex. Stress was measured using the Perceived Stress Questionnaire, and anxiety and

depression using the Hospital Anxiety and Depression Scale. Results indicated that stress and

anxiety were higher in the migraine group than in the control group and above the clinical

level. Depression scores remained low in both groups, under clinical relevance. Stress is a

primordial factor in the triggering and perpetuation of migraine attacks. The high score of the

items ‘morning fatigue’, ‘intrusive thoughts about work’, ‘feeling under pressure’,

‘impatience’, and ‘irritability’ of the stress questionnaire in the migraineurs is particularly

significant in the intensive stress response. It seems necessary to manage stress to improve

the daily life of migraineurs and to study the link between stress, anxiety and migraine.

Physical causes can be Tiredness and insufficient sleep, shoulder or neck tension,

poor posture, and physical overexertion have all been linked to migraines. Low blood sugar

and jet lag can also act as triggers. Triggers in the diet could be alcohol and caffeine can

contribute to triggering migraines. Some specific foods can also have this effect, including

chocolate, cannabis, cheese, citrus fruits, and foods containing the additive tyramine.

Irregular mealtimes and dehydration have also been named as potential triggers. In

medications Some sleeping pills, hormone replacement therapy (HRT) medications, and the

combined contraceptive pill have all been named as possible triggers. In environment, the

flickering screens, strong smells, second-hand smoke, and loud noises can set off a migraine.

Stuffy rooms, temperature changes, and bright lights are also possible triggers (Helen, 2017).
 8

Treatment

Once migraine is diagnosed, and illness severity has been assessed, clinicians and

patients should work together to develop a treatment plan based on the patient needs and

preferences. The goals of the treatment plan usually include reducing attack frequency,

intensity, and duration; minimizing headache-related disability; improving health-related

quality of life; and avoiding headache escalation and medication misuse. (Richard B, 2004).

Medical treatments for migraine can be divided into preventive drugs, which are taken

on a daily basis regardless of whether headache is present, and acute drugs taken to treat

individual attacks as they arise. Acute treatments are further divided into nonspecific

and migraine-specific treatments. The US Headache Consortium Guidelines recommend

stratified care based on the level of disability to help physicians individualize treatment.

Simple analgesics are appropriate as first-line acute treatments for less disabled patients; if

simple analgesics are unsuccessful, treatment is escalated. (Richard B, 2004).

For those with high disability levels, migraine-specific acute therapies, such as the

triptans, are recommended as the initial treatment, with preventive drugs in selected patients.

A variety of behavioral interventions are helpful. The clinicians have in their

armamentariums an ever-expanding variety of medications. With experience, clinicians can

match individual patient needs with the specific characteristics of a drug to optimize

therapeutic benefit. (Richard B, 2004).

There was a research conducted on the usage of cannabis so the research was to

determine about the effects of inhalation of cannabis. Findings of the research explored for

the tolerance of these effects. There were significant reductions in headache and migraine

ratings after cannabis use men reported larger reduction than females are the concentrations

were associated.
 9

Some nonpharmacological treatments can be used as well which can be

understanding how lifestyle impacts the severity and frequency of migraine attacks can be a

large part of successful migraine prevention. The key is to develop consistent patterns for all

days of the week. Lifestyle changes should be undertaken gradually and over time. Such as

sleep, exercise, eating, reduce stress and improvement posture. Another treatment can be

Behavioral treatments such as biofeedback therapy and coping skills while another can be

complementary treatments such as Acupuncture/Acupressure, Manipulative procedures and

Massage.

Theories of Migraine

Older theories suggest that migraine is due to some fluctuations occur in blood flow, but new

one suggested that variation in blood flow or blood vessels does not cause migraine but these

factors may contribute to initiate or cause migraine.

Vascular theory. This is the oldest theory of migraine proposed by Graham in 1664 and

revised by Wolff in 1938. According to this theory, vasoconstrictions occur during an aura

where after dilation leads to headache. They suggested that migraine has two phases. In

phase I, also known as prodromal phase is characterized by vasospasm causes neurological

symptoms. In phase II, results from compensatory vasodilation of intracranial and extra-

cranial vasculature. This theory is widely accepted all over the world before the next

revolutionary theory came.

Neuronal theory. This theory replaced the vascular theory of migraine. This theory is

proposed by Liveing and Gowers in 1873. This theory suggested that migraine occur due to

paroxysmal depolarization of cortical neuron. In simple words, excessive excitement of nerve

cell in cerebral cortex is the origin of the migraine.

Trigemino-vascular theory. This is the most accepted model of migraine in present time. This

theory is proposed by Muskowtz and colleagues in 1979 suggested that migraine occur due to
 10

depolarization of cortical neurons followed by reduction in posterior cerebral blood flow.

Moreover, genetics factors cause disturbance in the neural ion channels which allow variety

of the external and internal factors to trigger the episodes of the regional neural excitation.

This theory focuses on the relationship between the trigeminal nerves and intracranial

vessels.

Characteristics of Sample

The sample was consisted of 25 girls of age 20-25 that were the students of different

departments of B.S graduate program in Govt. Postgraduate College for Women, Gulberg,

Lahore. All the girls selected were suffering from some type of migraine.

Conclusion

Migraine is a primary headache that involves genetic and environmental factors. In studies,

migraine was shown to be underdiagnosed, treated insufficiently and highly related to

disability. The primary aim of the Migraine Awareness Project is to spread awareness about

the types, causes and treatment to the students. So that they will be able to appropriately

manage and prevent the migraine headaches.

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Chapter II

Methodology

A project of health was carried out in order to address the psychological problems of

students suffering from migraine.

Sample and sample size

A sample of 30 females with migraine were selected among which 15 girls were

selected from Govt Postgraduate college for women Gulberg Lahore, five were selected from

friends and family, and ten were selected from Mayo Hospital, Lahore. The purpose of study

was conducted to understand how psychological factors are influencing the studies of

females between the age of 18 to 25 years old who were suffering from migraine. A total of

30 questionnaires were distributed randomly. All the participants were given the verbal

information about the purpose of study before participation.

Rationale

The main purpose to conduct the health project on migraine issue is that it is

considered common problem in all ages. Youth faced a lot of complications in educational

area as well as in other important areas of life. According to a research article, the quality of

life of migraine patient was low other than normal group of people. It caused different

disabilities in life (Shaik et al., 2015).

So, we provide a detailed and clear awareness Campion to migraine patients among

college students. Providing them assessment test to clarify whether they have migraine or

having some common problem of headache. The aim of the Campion is to educate the patient

with the symptoms and effects of migraine, coping strategies for the migraine as well as its

psychological effects on them.

Procedure
 12

After approval of our project by the head of department and the informed consent

statement the project of awareness of migraine among university students began. Data from

30 students was collected and analysed. The purpose of the project was to study how

psychological, biological and social factors influence the student’s life who suffer from

migraine. Students from Govt. Postgraduate College for Women, Gulberg, some from Mayo

Hospital and out of family and friends were included. Students who were not present for any

reason during data collection were excluded. All the students completed and returned the

questionnaire in the first meeting. Their contacts were taken to arrange another meeting.

Upon next meeting with the same student’s psychological management plans were devised to

them based upon their filled questionnaires about the problems they were facing in their

study schedules. Triggering factors such as stress, noise, tiredness, dietary pattern, missed

meal chocolate intake, etc. were questioned and addressed. Those students who showed up

for another meeting were explained the about the management and other factors that were

negatively influencing psychological, biological and social factors and the coping skills were

introduced to them.

Suggestions

1. The present study involved females of age 18 to 23 the study must include the patients

of other ages too.

2. The study was only conducted on females it should also consider boys as well.

3. Only migraine patients were included in the awareness campaign, the rest of the

normal population should also be included.

4. Pre and post questioning must be done before and after campaign, so that we can

easily figure out the outcomes of awareness campaign.

 13

5. After the awareness campaign, a homework headache diary should be provided to

each and every participant, so that they have a clear understanding and record of the

reduction of the pain and effectiveness of the information provided to them.

Limitations

In the meeting of the students for the need to know their psychological, biological and

social factors being affected by migraine, psychological and social management was given.

The following limitations were observed:

1. No biological management was given to them as it too effected the sample of our

health project.

2. Some of the participants were showing non serious behavior during the meeting that

was causing environmental distractions.

3. Some students were not comfortable sharing their psychological effects on the basis

of being misdiagnosed psychologically.

 14

Chapter III

Discussion

The purpose of the project was to study how psychological, biological and social

factors influence the student’s life who are suffering from migraine. In a research it is well

documented that headache is a multifactorial disorder which includes not only genetic,

biological, medical and neuropsychological factor but also psychological and personality

traits. The close relationship between stress and migraine attacks and the significant

psychiatric comorbidities in migraine provide evidence of a “paradigm” of tight interaction

between somatic and psychological aspects in paediatric migraine. In particular in younger

children, an uncomfortable situation, a psychological problem or an emotional distress is

rarely expressed directly but usually through physical symptoms. So, migraine may be

considered as a disorder of psychobiological adaptation in which genetic predisposition

interplays with internal and/or external environmental influences such as psycho-emotional,

climatic, hormonal, dietary or other factors (Guidetti, Faedda & Siniatchkin, 2016).

A research article investigates migraine headaches in university students. They

revealed that migraine is considered as significant health problem among young people due

to its morbidity and frequency as well as loss of performance. Results revealed that migraine

type headache was detected in many participants. 43.8% were male (n= 706) and 56.2% were

female (n= 907) with migraine. Females participants has significant higher headaches rate

than males. Conclusion of the study revealed that migraine is common in adults as well as

among adolescents too (Oztora et al, 2011). So, this research shows that migraine is common

nearly in all ages not only in adults as we also considered this in our rationale.

Migraine and mood disorders are studied by Rammohan et.al in 2019 finding that

migraine is one of the prevalent disorders in the world. Migraine may cause irritability that

may lead to mood disorders. The age ranges from 25-50 years and participants were 133
 15

totals in number. The duration and frequency of migraine headaches were found to correlate

with the presence of mood disorders and the migraine-related disability in patients with

comorbid mood disorders was significantly higher (Rammohan et.al, 2019). Migraine cause

disturbance in different life areas by disturbing physical and mental health. Adults are facing

a significant disturbance in major areas of life as mentioned in rationale of our research.

Questionnaires were used to collect data collection in our project. A survey-based

study on the awareness of migraine among university students and professionals was

conducted in which a specially designed questionnaire was used for data collection. The

prevalence of migraine in the students and professionals was checked and data about the

causes of migraine from the persons suffering from migraine was also collected (Naveed,

Hameed & Sharif, 2014).

Triggering factors were found to be stress, noise, tiredness, dietary pattern, missed

meals, chocolate intake, etc. which were addressed. According to a research the exact causes

of migraine are not fully understood. But migraines can be triggered by, diet (foods such as

coffee, tea, cheese, alcoholic beverages or nuts), strong odours like perfumes, bright lights,

loud noises, changes in the weather, stress, sleeping more or less than usual, certain

medications. The patient may feel tired in this phase and have head pain, gastrointestinal

symptoms, cognitive difficulties, weakness and mood changes. Some people feel euphoric

after an attack (Naveed, Hameed & Sharif, 2014).

The study was only conducted on females it should also consider boys as well. Many

researches have shown that migraine is more common in females than males that is why

females are selected. According to a research migraine is more severe in females because

female patients seemed to be more anxious and had more severe impairment in attentive

processing of visual stimuli than their male counterparts. Thus, it showed that migraine might

had an additional influence on females and lead to more dysfunction in their interictal
 16

neurocognitive processing and hence a gender effect exists in migraineurs that must be

considered when designing experiments and exploring treatment approaches (Guo. Y, Xu. S,

Nie. S, Han, M, 2019).

A homework headache diary should be provided to each and every participant, so that

they have a clear understanding and record of the reduction of the pain and effectiveness of

the information provided to them. According to a research electronic diary were used in a 3-

month multicenter study to record no headache symptoms before, during, and after migraine.

Symptoms were entered in the diaries by patient initiation and through prompted entries at

random times daily. Using an electronic diary system, the research show that migraineurs

who report premonitory symptoms can accurately predict the full-blown headache (Giffen. J.

N, Ruggiero. L, Lipton. R, Silberstein. D. S, 2003).

In the meeting of the students for the need to know their psychological, biological and

social factors being affected by migraine, psychological and social management was given.

Limitation emerged at the point where no biological management was given to them as it too

effected the sample of our health project. According to a research A comparison was carried

out of the efficacy of psychological and drug treatments for children with migraine. Forty-

three children aged between 8 and 16 years (mean age: 11.3 years) who suffered from

migraine received either progressive relaxation or cephalic vasomotor feedback, both with

stress management training, or metoprolol, a beta-blocker. When comparing pre- to post-

treatment data, children treated with relaxation training improved significantly in headache

frequency and intensity, whereas those treated with cephalic vasomotor feedback improved

significantly in headache frequency and duration as well as mood which shows importance of

pharmacological treatment along with psychological (Sartory, 1998).

The participants were showing non serious behavior during the meeting that was

causing environmental distractions. According to an article learning depends on several

 17

factors, but a crucial step is the engagement of the learner. This is affected by their

motivation and perception of relevance. These, in turn, can be affected by learners' previous

experiences and preferred learning styles and by the context and environment in which the

learning is taking place. In adult learning theories, teaching is as much about setting the

context or climate for learning as it is about imparting knowledge or sharing expertise

(Hutchinson, 2003).

Some students were not comfortable sharing their psychological effects on the basis

of being misdiagnosed psychologically. Denis Campbell for The Guardian writes that

Among the 85% whose diagnosis was delayed, 71% said that their symptoms had become

worse as a result of receiving inappropriate treatment, such as antidepressants or sleeping

pills (Kvarnstrom, 2017).

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References

Guidetti, V., Faedda, N. & Siniatchkin, M. (2016). Migraine in childhood: biobehavioural or

psychosomatic disorder? Headache Pain 17, 82. https://doi.org/10.1186/s10194-016-

0675-0

Naveed, Hameed & Sharif, (2014). Awareness and prevalence of migraine, survey-based

study in Karachi. 1. 157-161.

Oztora, S., Korkmaz, O., Dagdiveran, N., Celik, Y., Cylan, A., Top, S. M., & Asil, T. (2011).

Migraine headaches among university students using id migraine test as a screening

tool. Journal of BMC med,11(1):103. Doi: 10.1186/1471-2377-11-10

Rammohan, K., Mundayadan, M. S., Das, S., & Shaji, V. C. (2019). Migraine and Mood

Disorders: Prevalence, Clinical Correlations and Disability. Journal of neuroscience in

rural practice, 10(1):28-33. doi: 10.4103/jnrp.jnrp_146_18

Sartory, G., Müller, B., Metsch, J., & Pothmann, R. (1998, October 19). A comparison of

psychological and pharmacological treatment of pediatric migraine. Retrieved June

20, 2020, from

https://www.sciencedirect.com/science/article/abs/pii/S0005796798000813

Shaik, M. M., Hassan, B. N., Tan, L. H., & Gan, H. S. (2015). Quality of life and migraine

disability among Female migraine patient in the tertiary hospital of Malaysia. Biomed

Res Int, doi:10.1155/2015/523717

Guo. Y, Xu. S, Nie. S, Han, M, (2019). Female versus male migraine: An event-related

potential study of visual neurocognitive processing. The Journal of Headache and

Pain, 20(1) doi: 10.1186/s10194-019-0995-y

Peng. P. K, Wang. J. S, (2012). Premonitory symptoms in migraine: An electronic diary

study. 60(6):935-40 doi: 10.1212/01.WNL.0000052998. 58526.A9

 19

Hutchinson, L. (2003, April 12). Educational environment. Retrieved June 20, 2020, from

https://www.bmj.com/content/326/7393/810.full

Kvarnstrom, E. (2019, July 16). The Dangers of Mental Health Misdiagnosis: Why Accuracy

Matters. Retrieved June 20, 2020, from https://www.bridgestorecovery.com/blog/the-

dangers-of-mental-health-misdiagnosis-why-accuracy-matters/
Appendix A
Pre and Post Questions

1. Have you ever had a delay or absence in your academic environment due to migraine?

2. Do you think migraine caused you to limit yourself in family gatherings?

3. Have you ever felt depressed due to your increase in migraine episodes?

4. Do you think you had to face medical conditions apart from headache during migraine

attacks?

5. Have you ever tried to control your triggers to avoid migraine attacks?
Appendix B