Assessing Frequency Of Migraine It’s Associated Factors Among The

Undergraduate Students of Gajju Khan Medical College, Swabi

Supervised by: Dr. Ayesha Jamil

Co-Supervisor: Dr. Zainab Khattak

Submitted by: Ammar Hussain Dar

Roll no: 42

Department of Community Medicine

Gajju Khan Medical College

MTI, Swabi

2021
 SUPERVISOR CERTIFICATE
I, hereby, certify that, Ammar Hussain, Roll No. 42 has successfully completed his research
project entitled “Assessing Frequency Of Migraine And It’s Associated Factors Among The
Undergraduate Students of Gajju Khan Medical College, Swabi”.

He has been working under my supervision. The enclosed Report is prepared according to the
Departmental guidelines. I have read the thesis and have found it satisfactory as per requirements
of the department.

SUPERVISOR’S NAME:

Dr. Ayesha Jamil

DESIGNATION: Assistant Professor

CO-SUPERVISOR’S NAME:

Dr. Zainab Khattak

DESIGNATION:

Health Educator,

Department of Community Medicine

MTI- Gajju Khan Medical College Swabi.

SUPERVISOR’S SIGNATURE: _________________________

DEPARTMENT STAMP: __________________________

DATE OF SUBMISSION: __________________________

DEDICATION:

This work is dedicated to the field of Medicine .

 ACKNOWLEDGEMENT
I am extremely grateful to Almighty ALLAH who gave me the knowledge and strength to
complete this research project. It was a wonderful experience to participate in this project for that
I am very thankful to Prof. Dr Ibrar Lakhkar and Department of Community Medicine
which gave me the opportunity and resources. The continuous support and giddiness of
department at every step regarding this project despite the presence of pandemic of covid-19 was
remarkable. I would like to thank my Supervisor and Co-Supervisor Dr. Ayesha Jamil and Dr.
Zainab Khattak for putting their trust in me and helping me out with my project at every step. I
would also like to thank my colleagues Hasnat Ahmad, Mohsin Riaz, Samiullah for lending
me help.

AMMAR HUSSAIN
CLASS NO: 42
 AUTHOR’S DECLARATION

I Mr. AMMAR HUSSAIN hereby states that my research project entitled “Accessing Quality
of Life and its Impact on Academic Performance among the Undergraduate Students of
Gajju Khan Medical College, Swabi” is my own work and has not been submitted previously
by me for taking any degree from Gajju Khan Medical College, Swabi.

At any time, if my statement is found to be incorrect even after my graduate, the college has the
right to withdraw my research work.

Mr. Ammar Hussain

TABLE OF CONTENTS

CONTENTS PAGE NUMBER

ABSTRACT X

CHAPTER 1

INTRODUCTION 1
OBJECTIVE 2
CHAPTER 2

LITERATURE REVIEW 3
RATIONALE 4
CHAPTER 3

METHODOLOGY 5
STUDY DESIGN 5
OPERATIONAL DEFINITIONS 5
INCLUSION CRITERIA 5
EXCLUSION CRITERIA 5
STASTICAL ANALYSIS 6
STUDY DURATION 6
TECHNIQUE 6
SAMPLE SIZE 6
PRETESTING 6
TOOL FOR DATA COLLECTION 6
VARIABLES 6
CHAPTER 4

RESULTS AND ANALYSIS 8

CHAPTER 5

DISCUSSION 22
LIMITATIONS 25
CONCLUSION 25
RECCOMENDATIONS 25
CHAPTER 6

REFRENCE 26
CHAPTER 7
ANNEXURES 29

VI
 LIST OF TABLES
Table. No TITLE Page No

1 Total Number of Respondents And Their Gender 8

2 Stats of Exclusion Criteria 9
3 Age of the Respondents Included In Research And Range Of 10
Their Age
4 Class of the respondents 11
5 Age Of onset of Migraine 12
6 Frequency Of Migraine Episodes 13
7 Account of associated factors experienced by Respondents 14

VII
 LIST OF GRAPHS

Graph No TITLE Page No

1 Graphical Representation Of Gender of the Respondents 8

2 Graphical Representation Class of the Respondents 9
3 Graphical Representation Of Age 10
4 Graphical Representation Of Class Of Respondents 11
5 Graphical Representation Of Onset Age 12
6 Graphical Representation Of episodes of migraine 13
7 Graphical Representation Of Associated Factors 14
8 Association Of Level Of Stress And Migraine 15
9 Stress Management 15
10 Association Between Falling Asleep And Migraine 16
11 Association Between Sleep Interruption And Migraine 16
12 Association Between Smoking And Migraine 17
13 Gender Of Smoker 17
14 Family association with migraine 18
15 Family member with migraine 18
16 Other Associated Factors 19
17 Know Diseases 19
18 Nature Of Migraine 20
19 Location Of Migraine 20
20 Frequency Of Migraine In Different Classe 21

VIII
 LIST OF ABBEREVIATIONS

WHO World Health Organization

Health related quality of life

HRQoL

International Headache Society

IHS

SPSS Statistical Package For Social Studies

IX
ABSTRACT

ABSTRACT:
INTRODUCTION:
Headache is among the commonest complaints in medical students; it could be due to many
physical or psychological stressors. It has two main types: primary (including tension‑type,
migraine, and cluster) and secondary. Migraine is a chronic health issue having a global
prevalence of more than one billion people and is one of the most common primary headache
disorders and is burdensome to both the individual and society. Migraine impairs daily activities
of sufferers and hence influencing the academic performance and quality of daily lives of
medical students worldwide.

METHADOLOGY:
A cross sectional study was conducted at Gajju Khan Medical College during July 2021 to
November 2021. International Classification of Headache Disorder-II criterion was used to
diagnose and classify headache. The frequency, duration of attacks, severity and trigger factors
were measured for migraine cases. SPSS 25 was used for statistical analysis.

OBJECTIVES:
• To assess the frequency of migraine in medical students
• To find out the associated factors for migraine in medical students
•To find out the coping strategies for stress related migraine in medical students
•To find out the characteristics of migraine in medical students

RESULTS:
Frequency of Migraine was 73.5% (62% in males and 38% in females). The associated factors
which formed the major chunk were Stress 25%, Smoking 22%, Sleep Disturbances 16%,
Photophobia 12%, Menstruation 10%, Known Disease 3%, Phonophobia 3%.

CONCLUSION:
This present study showed that frequency of migraine and its associated factors in medical
students of Gajju Khan Medical College Swabi. Stress 25%, Smoking 22%, Sleep disturbance
16% and were the most commonly experienced migraine associated factors.
In conclusion, associated factors are frequent, its detection must be detailed, and so that
preventive treatment could be more efficient. Avoiding migraine triggers factor can possibly
decrease headache frequency and also potentially improve patients’ quality of life.
KEYWORDS:
Headache, Migraine, Tension-type headache, Cluster-type headache, Frequency, Quality of life.

X
INTRODUCTION CHAPTER 1

INTRODUCTION

Headache, or its medical term "Cephalgia", is one of the common medical ailments that is not
only considered a nuisance but also has a negative impact on the quality of life, making the
person too ill to perform his routine daily activities properly11. World Health Organisation
(WHO) has ranked headache among the top 10 disabling conditions, worldwide. Headache is
classified into two types primary and secondary. Primary disorders of headache include migraine
and tension-headaches(2). Primary headache disorders including migraine and tension-type
headache (TTH) are of great importance to global public health due to its high prevalence(3).
However, migraine is the focus of this study. Migraine is a chronic neurovascular disorder in the
brain. Migraine headache is commonly throbbing and unilateral, and it is associated with
photophobia, phonophobia and/or nausea. It could be so severe that it interferes with daily
activity(4). It is a chronic health issue having a global prevalence of more than one billion
people(14.7% of the world’s population)(5) with a preponderance of women among the
migraineurs(6). Migraine impairs daily activities of sufferers and is ranked by the Global Burden
of Disease as the 3rd principle cause of disability in people under 50 years of age(7). Previous
studies have linked this condition to certain predictors like GI disorders and family history of
migraine(8). Studies have also assessed triggering factors of this disorder and medical students
appear to be at risk; these students have a heavy study load, demanding schedules and clinical
responsibilities which may result in stress(9) sleep deprivation and irregular dietary habits. All of
these are common triggers that can increase the frequency of migraine(10, 11). Considering that
studies have shown a decline in academic output(12) and an increase in absence from academic
institutes among the affected(13) a worrisome situation arises for the society given the future
role of medical students as health professionals. It is a complex condition with many patho-
physiological mechanisms, such as hypothalamic dysfunction and a possible hyper dopaminergic
state(14). Migraine patients might suffer from anxiety between attacks due to fear of the next
attack. Thus it is a continuous struggle of treating one attack and fearing the next. This decreases
the quality of lifestyle(15). Headache is very common in medical students(16, 17) and it has been
shown that 40% of medical students had various types of headache and 40.2% of these
headaches were migraine(18). In Pakistan much higher frequency of Migraine (37.5%) has been
reported among postgraduate medical students(19).

1
 INTRODUCTION CHAPTER 1

OBJECTIVES:
 To assess the frequency of migraine in medical students
 To find out the associated factors for migraine in medical students
 To find out the coping strategies for stress related migraine in medical students
 To find out the characteristics of migraine in medical students

2
LITERATURE REVIEW CHAPTER 2

LITERATURE REVIEW

Primary headache disorders including migraine and tension-type headache (TTH) are of great
importance to global public health due to its high prevalence(3). Migraine which is the main
cause of headache worldwide is characterized by headache attacks that last between 4 and 72 h if
untreated. It is one-sided pulsating or throbbing pain of moderate to severe intensity and
associated with nausea or vomiting or both photophobia and phonophobia(20). Tension-type
headache (TTH) is a headache where the pain is commonly described as “a band around the
head”. It has at least two of the following characteristics: mild to moderate in intensity, occurs on
both sides of the head (bilateral), and not worsened by routine activity (bending over or climbing
stairs), and pain has a pressing or tightening quality and not throbbing or pulsing. It is also not
accompanied by nausea or vomiting(21). Previous studies have shown a high prevalence of
headache among university students(22, 23). Students’ lifestyle puts them at high risk to suffer
from fatigue, stress, and anxiety which are the most common causes of TTH and migraine(24).
Headache can make students suffer lost days of study, impaired academic performance and poor quality
of life(24). It is estimated that globally, among the adult population, 46% have headache in
general, 11% have migraine, 42% have tension-type headache (TTH),and 3% have chronic daily
headache(4). The quality of life for individuals with headaches can be compromised by several
factors, such as the presence of physical and emotional limitations, an impact on professional and
academic activities because of absences and a drop in labor productivity because of pain or to
related symptoms. A patient’s social and family life is also compromised. Such factors can
represent a high cost to society(25). Annual indirect costs related to migraine in the United States
were estimated between US$ 1.4 and 17 billion(26). In Brazil, it is estimated that migraine alone
is responsible for 4,016,076 consultations in primary care settings, 3,887,504 in secondary care
and 93,103 in tertiary care per year, generating an annual direct medical cost of approximately
US$ 140 million(27). Studies suggest that headaches can contribute to a reduction in student
academic performance(28-31). A previous study reported that 62.7% of migraine-suffering
students claimed a reduction in academic performance during a headache attack. This research
reported a mean of 5.8 days that students did not study at home and of 1.6 days that they missed
classes because of headache in 6 months. A total of 24.4% TTH-suffering students reported a
reduction of their academic performance during headache episodes. There was a mean of 1.5
days that they did not study at home and of 0.3 days that they missed classes because of

3
LITERATURE REVIEW CHAPTER 2

headache during the 6 months prior to the study(29). A study of medical students at a Brazilian
university showed that headaches exert greater influence over academic performance than sex,
state of origin, smoking habits, consumption of alcoholic beverages, practice of extracurricular
activities, work and stress. There was association between headache and the need to do recovery
exams(30).

A study was conducted by Noor T which showed that 21% of medical students had migraine(32).

Another study was conducted by Khan A showed that 38.3%of medical students had
migraine(33).

RATIONALE:

I, being a medical student have experienced the episodes of migraine during exams. I have felt it
quite often that if I wouldn’t have episodes of migraine I could have better academically. I want
to assess the frequency of migraine and it’s associated factors. My study will help teachers,
administration and parents to work on improving the good quality of life to help students achieve
their goals easily .it will help to educate students about the associated factors of migraine which
if they can avoid might have a beneficial impact on academic performance.

4
METHODOLOGY CHAPTER 3

METHODOLOGY

OPERATIONAL DEFINITIONS:

Migraine:

Migraine is a chronic neurological disorder which makes daily activities less functional and also
has a negative effect on quality of life.

Quality of Life:

Quality of life of the respondents means their scores in all four domain of quality of life as
present in WHOQOL-BREF. Respondent with high score will have good quality of life and
respondent with low score will have low quality of life.

STUDY DESIGN:

This was a descriptive, cross-sectional study. The data from participants was collected through
online questionnaire. All participants were included after obtaining informed written consent
from them that included the demographic and other related information. This was also completed
at the time of questionnaire collection.

SELECTION CRITERIA:

Inclusion Criteria:

All the students of Gajju Khan Medical College from 1st to 5th year were included in this study.

Exclusion Criteria:

1) Those who didn’t had headache

2) Those who had bilateral involvement.

STUDY LOCATION:

Gajju Khan Medical College, Swabi (GKMCS) was the location of study.

5
METHODOLOGY CHAPTER 3

STUDY DURATION:

This study was conducted from July to November 2021.

SAMPLE SIZE:

The total responses were 136, which were collected through an online questionnaire.

SAMPLING TECHNIQUE:

The study employed simple random sampling technique to gather responses from the
undergraduates.

TOOLS FOR DATA COLLECTION:

The data of this survey was collected from the students’ self-reports by filling the online
questionnaire. The questionnaire included demographic data, such as: age, gender family history
of headache, and specific questions about headache based on the IHS Also different
characteristics of headaches such as: frequency, duration, location, quality, and intensity of pain,
influence of physical activity work intensity nausea, vomiting, and photophobia and different
Associated factors such as: stress, sleep disturbances, smoking etc. were questioned.

VARIABLES:

Age, studying class, result in percentage were quantitative variable and quality of life, migraine,
pain, stress, sleep disturbance and most of other variables were qualitative variables.

PRETESTING:

The questionnaire was given to a few of my classmates. The purpose of study was explained to
them. They understood the questions easily.

6
METHODOLOGY CHAPTER 3

DATA ENTRY AND ANALYSIS:

The data obtained from respondents was analyzed using statistical package for social sciences
(SPSS) version 25. Questionnaire was codified first and then entered into the SPSS. Descriptive
and inferential analysis was done under the supervision of research coordinator.

DATA PRESENTATION:

Data presented in the form of graphs and tables.

ETHICAL CONSIDERATION:

The protocol of this study was approved by Ethical Review Board of GKMCS. The participant’s
confidentiality was guaranteed and safeguarded. Informed consent was obtained from
participants prior to study.

7
RESULTS CHAPTER 4

RESULTS AND ANALYSIS

The total number of students included in this study were 136.Out of 136, 81 were males and 55
were females. Students of different classes were included in our study. Out of 136 students, 38
were from 4th year, 17 were from 3rd year, 18 from 5th and 11 were from 2nd year, 16 were from
1st year respectively. Age of the respondents ranged from 18 to 25 years with mean age of 22.36.

Table No 1: Total Number of Respondents And Their Gender

Participants

Number Of Male
Participants 81

Number Of Female
Participants 55

Total Number Of
Participants 136

Graph no 1: Percentages of Gender of the Respondents

Participants

40%
Male
Female
60%

8
RESULTS CHAPTER 4

Table No 2: Stats of Exclusion Criteria

Stats Of Excluding
Criteria

Don’t Have
Headache 26

Headache With
Bilateral
Involvement 10
Total 36

Table no 2 shows the stats of exclusion criteria. Those who didn’t had headache or ha bilateral
involvement were excluded.

Graph No 2: Class of the Respondents

9
RESULTS CHAPTER 4

Table No 3: Age of the Respondents Included In Research And Range Of Their Age

Minimum Maximum
Number Of Students Age Age Mean Std. Deviation
22.36
1oo 18 Years 25 Years Years 1.75

Table no 3 depicts age of the respondents. Maximum no of respondents was of age group 23-24
and minimum no of the respondents were from age group 20-22. The mean age of the
respondents was 22.47.

Graph No 3:Graphical Representation Of Age

Age
40
35
Number of students

30
25
20
15
10
5
0
18 19 20 21 22 23 24 25
Age of the students

Graph no 3 depicts the age of respondents showing that most of the respondents were of 23
years of age.

10
RESULTS CHAPTER 4

Table no 4: Class of the respondents

CLASS Representation
Cumulative
CLASS Frequency Percent Percent
1st Year 16 16 16
2nd Year 11 11 27
3rd Year 17 17 44
4th Year 38 38 82
Final Year 18 18 100
Total 100

Table no 4 Table no 4 shows class of the respondents. Out of 100, 16 were from 1 st year, 11
were from 2nd year, 17 were from 3rdyear, 38 were from 4th year and 18 were from 5thyear. The
students of 4th year were 37.6 % followed by the number of respondents from 3 rd year which
were 32.7%, then 9.9% were from 2nd year and 19.8% were from 5thyear.Graphical
representation in graph no 4
Graph No 4: Graphical Representation of Class Of Respondents

Graph no 4 shows the graphical representation of class of respondants. This graph shows that
most of the respondants were from 4th year and least number were from 2nd year.

11
RESULTS CHAPTER 4

Table no 5: Age Of onset of Migraine

ONSET OF MIGRAINE

Number Of
Student Who Number Of Number Of
Had Onset In Students Who Had Students Who Had Total Number Of
Childhood Onset In Teenage Onset In Twenties Students
14 39 47 100

Table No 5 shows the age of onset of migraine, this shows that most of the students had their
In twenties.
Graph No 5 Onset

ONSET

25%
Teenage
Chilhood
14% 61% Twenties

Graph no 5 shows that percentage of onset of migraine among respondents. This graph shows
that 61 percent of respondents had their onset of migraine in their twenties.

12
RESULTS CHAPTER 4

Table no 6: Frequency Of Migraine Episodes

After Few Days After Few Weeks After Few Months Few Times A Year
28 21 25 26

Table No 6: shows the frequency of episodes of migraine among respondents. This shows that
most of the students have an episode of migraine after every few days.

Graph No 6: Percentage of episodes of migraine

Frequency Of Episodes

26% 28% days

weeks
months
year
25% 21%

Graph No 6: shows frequency of Migraine in percentage. This table shows that 28% of students
have an episode of migraine in every few days, 21% have episodes in few weeks, 25% have an
episode of migraine in months and 26% have an episode of migraine in year.

13
RESULTS CHAPTER 4

Table No 7: Gives an account of associated factors experienced by Respondents

Associated Factors
Sleep Disturbances
Stress
Smoking
Caffeine Consumption
Family History
Menstruation
Known Disease
Photophobia
Phonophobia
Others

Graph No 7: Gives an account of associated factor experienced in Percentage

Associate factor Stress

4% 3% Sleep
12% Smoking
3% Family History
25%
Mensturation
10% Known Disease
Photophobia
5% 22% 16%
Phonophobia
Others

Graph No 7 is giving the account of associated factor related to migraine and the experiencing
frequency among the respondents. This graph exhibits that stress is most common associated
factors experienced by 25% of the respondents followed by smoking and sleep disturbances by
22% and 16% respectively.

14
RESULTS CHAPTER 4

Following would exhibit the stats of some of the major associated factors including stress, sleep
disturbances in form of tables and graphs when respondents were independently asked about
them.
Stress Related Stats:
Graph No: 8 Association Of Level Of Stress And Migraine

Level
Of Stress

13% 17% Mild

Moerate
29% High
41% Very High

Graph No 8 shows the level of stress perceived by medical students, it depicts that out of those
26% those who experienced stress, 41% perceived their stress to be moderate followed next by
29% who termed their stress as high making them vulnerable to episode of migraine.

Graph No 9: Stress Management

Stress Management

14%
Prayer/S piritual activities
Family Interaction
16% 46%
Social Interaction
Exercise

16% Relaxational techniques

8%

Graph No 9 depicts that out of those who experience stress 46% relieved their stress through
offering prayers/engaging in spiritual activities, followed next by exercise and social interactions
used by similar percentage of respondents i.e; 16%. Family interaction and relaxation techniques
were used by 8% and 14% respectively.
15
RESULTS CHAPTER 4

Graph No 10: Association Between Falling Asleep And Migraine

Facing Problem While Falling Asleep

45% yes

55% no

Graph No 10 shows out of those 16% who had sleep disturbances 45% faced difficulty falling
asleep.

Graph No 11: Association Between Sleep Interruption And Migraine

Sleep interruption

45% yes

55% no

Graph No 11 shows that out of those 16% who had sleep disturbances 55% of them had sleep
interruptions.

16
RESULTS CHAPTER 4

Graph No 12: Association Between Smoking And Migraine

Smoking Stats

22%

non smokers
smoker

78%

Graph No 12 shows that out of those who had migraine 22% were smokers.

Graph No 13: Gender Of Smoker

Gender Of Smoker
5%

Male
Female

95%

Graph No 13 shows the gender of smokers. This graph exhibits that major chunk of
smoker were male.

17
RESULTS CHAPTER 4

Graph No 14: Family association with migraine

Family History Of Migraine

5%

Yes
No

95%

Graph No 14 shows that only 5% of the respondents having migraine have positive family
history.

Graph No 15: Family member with migraine

Family Member Having Migraine

20%

Mother
40%
Father
Sister
20%
Cousin

20%

Graph No 15 shows out of those respondents having positive family history, the frequency of
mother being affected is twice then the other family members.

18
RESULTS CHAPTER 4

Graph No 16: Other Associated Factors

Other Associated factors

25% Letdown After Stress

Certain Smell Perfume

50%

Coughing, Straining,
25% Bending

Graph No 16 gives an account of other associated factors experienced by fewer respondents. It

depicts that among other associated factors letdown after stress is most commonly experienced.

Graph 17: Know Diseases

Known Disease

20% 20%
Ulcer
Anemia
Hypertention

60%

Graph No 17 gives an account of Known Diseases that few of the respondents are carrying. It
depicts that Anemia is most common disease among them.

19
RESULTS CHAPTER 4

Following graphs will highlight few major characteristics of migraine that were associated with
respondents.

Graph No 18: Nature Of Migraine

Nature Of Migraine
5%

15% Throbbing/Pounding
Ache/Pressure
50%
Like A Thight Band
30%
Dull

Graph No 18 shows that the nature of migraine in most of the respondents was found to be
throbbing/pounding followed next by ache/pressure.

Graph No 19: Location Of Migraine

Graph No 19 depicts the location of migraine. It shows in most of respondents the involved site was
behind the right eye.

20
RESULTS CHAPTER 4

Following graph would show the frequency of migraine in different classes of Gajju Khan Medical
College.

Graph No 20: Frequency Of Migraine In Different Classes

Frequency Of Migraine In Different

Classes

18% 16%
1st
2nd
11%
3rd
4th
38% 17%
Final

Graph No 20 shows the frequency of migraine among different classes. This exhibits that the frequency
of migraine is high in 4th class 38 % followed by 1st year 18% and final year 17%.

21
DISCUSSION CHAPTER 5

DISCUSSION
To the researcher’s best knowledge, migraine has not been previously the subject of an investigation in
medical students of Gajju Khan Medical College. This is the first study of its kind conducted on the
frequency of migraine and it’s associated factors among students of Gajju Khan Medical College Swabi.

Epidemiological studies have suggested that age, sex, genetic characteristics, and socio-culture
differences affect the prevalence of migraine(34).

The result of the present study based on international headache society (IHS) criteria (2004),
showed that the frequency of migraine in the medical students of Gajju Khan Medical College is
73% which is higher than the result of study conducted by Khan A(33) which showed that the
frequency of migraine among medical student of Peshawar was 38.3% and another study
conducted by Noor T(32) showed that frequency of migraine was about 21% but the result of this
study was comparable with a study that was conducted among Brazilian medical students(35)
which showed that the frequency was 64.72%. This high frequency might be due to the fact that
prevalence of stress seemed to be high among medical students. Academic burden, workload,
sleep deprivation and increased psychological pressure are assumed to be major "stress factors"
for medical students which not only affect their medical performances, but also all aspects of
health.

This study demonstrated male students to have higher frequency of migraine compared to female which is
contrary to studies(32,33). A large part of male students' contribution in the sample size could be
the possible reason for this. However, the frequency of migraine is compatible and supported by
other(32,33) studies.

This study demonstrated that the most common association to migraine was stress which was
reported by 25% of respondents, the result of the study is comparable to the studies(32,33) which
showed 20% and 35% of respondents reported stress. This study also indicates that 46% of those
who reported stress use offering prayers/spiritual acts to cop stress.

This study demonstrated that sleep disturbances had an association to migraine because 16% of
the respondents reported sleep disturbances which is comparable to study(32) but far less than
study(33) which indicated 35% of the respondents had sleep disturbances. This study also
indicates that 45% of those who reported sleep disturbances face difficulty falling asleep while
55% of them had sleep interruptions.

Nicotine is one of the other environmental trigger factors. Iribarren C et al have reported a
statistically significant increase in severe headaches correlating with total tobacco smoke
exposure time(36). Although cigarette smoke is a reported trigger for many migraineurs, in this
study it was 22% which is less than(33) which reported 41.29% were smokers. This study aslo
indiacted that 95% of smokers were male and 5% were female.

22
DISCUSSION CHAPTER 5

This study was unable to find any significant linkage of headache with family history compared
to other studies reporting strong association and high prevalence of headache in family especially
those of migraine which is comparable with the study result of Noor T(32). A higher prevalence
of family history among migraine patients highlights the role of genetics. Migraine is a polygenic
disease i.e. several genes have minor contributions to its pathophysiology and genetic
predisposition combines with environmental triggers to cause clinical symptoms. The search for
genes that predispose to migraine has not yielded uniform results to date most likely due to
heterogeneity of patients studied and lack of a reliable endophenotype to classify the disease.

This study found out that nature of migraine for most of the respondents was throbbing/pounding
which is comparable to the study result of Ojini F(1).

This study exhibited that migraine involved an area behind right eye in most of the students.

This study showed that the highest frequency of migraine was in 4th year.

23
 DISCUSSION CHAPPTER 5

LIMITATIONS OF STUDY:

This study represents the migraine frequency and its associated factors among the students f
Gajju Khan Medical College, and may not represent the entire community of medical students in
province or country.

CONCLUSION:

This present study showed that frequency of migraine and its associated factors in medical
students of Gajju Khan Medical College Swabi. Stress 25%, Smoking 22%, Sleep disturbance
16% and were the most commonly experienced migraine associated factors.
In conclusion, associated factors are frequent, its detection must be detailed, and so that
preventive treatment could be more efficient. Avoiding migraine triggers factor can possibly
decrease headache frequency and also potentially improve patients’ quality of life.

RECOMMENDATION:

A global education program may be required for patients to recognize the importance of effective
migraine treatment. Informing patients about the disease through informative programs is not
only an important step in the treatment of migraine attacks, but also reduces disability from
migraine.

25
REFERENCES CHAPTER 6

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8. Ibrahim NK, Alotaibi AK, Alhazmi AM, Alshehri RZ, Saimaldaher RN, Murad MA.
Prevalence, predictors and triggers of migraine headache among medical students and interns in
King Abdulaziz University, Jeddah, Saudi Arabia. Pakistan journal of medical sciences.
2017;33(2):270.
9. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and
other indicators of psychological distress among US and Canadian medical students. Academic
medicine. 2006;81(4):354-73.
10. Marmura MJ. Triggers, protectors, and predictors in episodic migraine. Current pain and
headache reports. 2018;22(12):1-9.
11. Andress‐Rothrock D, King W, Rothrock J. An analysis of migraine triggers in a
clinic‐based population. Headache: The Journal of Head and Face Pain. 2010;50(8):1366-70.
12. Yarnitsky D, Goor‐Aryeh I, Bajwa ZH, Ransil BI, Cutrer FM, Sottile A, et al. 2003 Wolff
Award: possible parasympathetic contributions to peripheral and central sensitization during
migraine. Headache: The journal of head and face pain. 2003;43(7):704-14.
13. Smitherman TA, McDermott MJ, Buchanan EM. Negative impact of episodic migraine
on a university population: quality of life, functional impairment, and comorbid psychiatric
symptoms. Headache: The Journal of Head and Face Pain. 2011;51(4):581-9.
14. Peres MFP, Del Rio MS, Seabra M, Tufik S, Abucham J, Cipolla-Neto J, et al.
Hypothalamic involvement in chronic migraine. Journal of Neurology, Neurosurgery &
Psychiatry. 2001;71(6):747-51.
15. Freitag FG. The cycle of migraine: patients' quality of life during and between migraine
attacks. Clinical therapeutics. 2007;29(5):939-49.
16. Amayo E, Jowi J, Njeru E. Headache associated disability in medical students at the
Kenyatta National Hospital, Nairobi. East African medical journal. 2002;79(10):519-23.

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17. Tahir M, Naeem N, Usman A, Iqbal H, Navied U, Erum S. Headache prevalence,

patterns and symptoms amongst medical students at Fatima Memorial College, Lahore. Pak J
Med Health Sci. 2010;4(4):542-3.
18. Sanvito WL, Monzillo PH, Prieto Peres MF, Martinelli MO, Fera MP, da Cruz Gouveia
DA, et al. The epidemiology of migraine in medical students. Headache: The Journal of Head
and Face Pain. 1996;36(5):316-9.
19. Aurangzeb S, Tariq M, Gul A, Hameed M. Frequency of various types of headaches
inpostgraduate medical students of a tertiary care hospital. Pakistan Journal of Neurological
Sciences (PJNS). 2008;3(1):1-5.
20. Lipton RB, Pavlovic JM, Haut SR, Grosberg BM, Buse DC. Methodological issues in
studying trigger factors and premonitory features of migraine. Headache: The Journal of Head
and Face Pain. 2014;54(10):1661-9.
21. Desouky DE, Zaid HA, Taha AA. Migraine, tension-type headache, and depression
among Saudi female students in Taif University. Journal of the Egyptian Public Health
Association. 2019;94(1):1-9.
22. Nandha R, Chhabra MK. Prevalence and clinical characteristics of headache in dental
students of a tertiary care teaching dental hospital in Northern India. Int J Basic Clin Pharmacol.
2013;2(1):51-5.
23. Shahrakai MR, Mirshekari H, Ghanbari AT, Shahraki AR, Shahraki E. Prevalence of
migraine among medical students in Zahedan Faculty of Medicine (Southeast of Iran). Basic and
clinical Neuroscience. 2011;2(2):20-5.
24. Souza‐e‐Silva HR, Rocha‐Filho PA. Headaches and academic performance in university
students: A cross‐sectional study. Headache: The Journal of Head and Face Pain.
2011;51(10):1493-502.
25. Bigal ME, Lipton RB. The epidemiology, burden, and comorbidities of migraine.
Neurologic clinics. 2009;27(2):321-34.
26. De Lissovoy G, Lazarus SS. The economic cost of migraine. Present state of knowledge.
Neurology. 1994;44(6 Suppl 4):S56-62.
27. Abdullah AS, Al-Musa HMA. Prevalence of recurrent headache and its association with
academic performance among King Khalid University male medical students. King Khalid
University Journal of Health Sciences. 2016;1(1):24.
28. Bicakci S, Over F, Aslan K, Bozdemir N, Saatci E, Sarica Y. Headache characteristics in
senior medical students in Turkey. The Tohoku journal of experimental medicine.
2007;213(3):277-82.
29. Bigal ME, Bigal JM, Betti M, Bordini CA, Speciali JG. Evaluation of the impact of
migraine and episodic tension‐type headache on the quality of life and performance of a
university student population. Headache: The Journal of Head and Face Pain. 2001;41(7):710-9.
30. CATHARINO AdS, Catharino F, Alvarenga R, Fonseca R. Cefaléia: prevalência e
relação com o desempenho escolar de estudantes de medicina. Migrâneas cefaléias.
2007;10(2):46-50.
31. Abu-Arefeh I, Russell G. Prevalence of headache and migraine in schoolchildren. Bmj.
1994;309(6957):765-9.
32. Noor T, Sajjad A, Asma A. Frequency, character and predisposing factor of headache
among students of medical college of Karachi. J Pak Med Assoc. 2016;66(2):159-64.

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33. Khan A, Khattak H, Jamali R, Rashid H, Riaz A, Ibrahimzai AK. Prevalence of migraine,
its common triggering factors and coping strategies in medical students of Peshawar. Khyber
Med Univ J. 2012;4(4):187-92.
34. Stewart WF, Lipton RB, Celentano DD, Reed ML. Prevalence of migraine headache in
the United States: relation to age, income, race, and other sociodemographic factors. Jama.
1992;267(1):64-9.
35. Ferri-de-Barros JE, Alencar MJd, Berchielli LF, Castelhano Junior LC. Headache among
medical and psychology students. Arquivos de neuro-psiquiatria. 2011;69(3):502-8.

36. Iribarren C, Friedman GD, Klatsky AL, Eisner MD. Exposure to environmental tobacco
smoke: association with personal characteristics and self reported health conditions. J Epidemiol
Community Health 2001;55:721-8.
37. Wessman M, Terwindt GM, Kaunisto MA, Palotie A, Ophoff RA.Migraine: a complex
genetic disorder. Lancet Neurol. 2007; 6:521-32.

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ANNEXURES CHAPTER7

ANNEXURE A

ETHICAL APPROVAL LETTER

To

The Research Ethics Committee,

Gajju Khan Medical College,

Subject: REQUEST FOR ETHICAL APPROVAL

Sir,

With due respect it is stated that, I Ammar Hussain from 4th year MBBS students at GKMC,
SWABI wants to conduct a research on the topic “Assessing Frequency Of Migraine It’s
Associated Factor Among The Undergraduate Students of Gajju Khan Medical College,
Swabi” for my project. This project will be conducted under the supervision of Dr.Ayesha Jamil
and Dr. Zainab Khattak.

For this purpose, I seek your approval for conducting my research on the topic mentioned above
on students of GKMC and request for the issuance of ethical letter.

I have provided you with the copy of my research proposal, if you require any further details
regarding it, you can contact me on ahdar1373@gmail.com

Thank you for your time and consideration.

Yours Obediently,

Ammar Hussain

4th Year

29
ANNEXURES CHAPTER7

ANNEXUREB

INFORMED CONSENT FORM

“Assessing Frequency Of Migraine It’s Associated Factor Among The

Undergraduate Students of Gajju Khan Medical College, Swabi”

I am conducting research study on the above mentioned topic. Regarding this study, you will be
asked few questions. It will take about 15 minutes of your time. You are requested to answer
these questions to the best of your knowledge. If you have any queries, you can ask to elaborate.
There is no risk involved in this study except your valuable time. There is no direct benefit to
you as well. However, the results of the study may help to formulate guidelines for improving
quality of life. You are free to choose to participate or refuse to participate in the study. The
information provided by you will remain confidential. Nobody except principal investigator will
have an access to it. Your name and identity will also not be disclosed at any stage. The data
obtained in this study will be used for research purposes only. If you have understood the
purpose, risks and benefits of the study, please sign below to confirm that you are willing to
participate in the study.

Participant’s Signature
Name: _______________________ Date: ________________________

Interviewer’s Signature
Name: _______________________ Date: ________________________

30
ANNEXURES CHAPTER7

ANNEXURE C
Migraine Headache Questionnaire

Name: Date:

Telephone (H): Telephone (secondary):

Date of Birth: □ Female □ Male

Marital Status: □ Married □ Single □ Divorced □ Widowed Race:

□ Caucasion □ Afr.Amer □ Hispanic □ Other

Occupation: Health Insurance Co:

1. How many migraine headaches do you experience per month? on average.

2. How many regular headaches do you have per month? on average.

3. How long do your migraine headaches usually last after you take your migraine medicine? (Check one)
□ No more than 2 hours □ 3-4 hours □ 5-12 hours □ 12-24 hours □ Several days 1 week or longer

How long do your migraine headaches usually last if you do not take your migraine medicine? (Check one)
□ No more than 2 hours □ 3-4 hours □ 5-12 hours □ 12-24 hours □ Several days 1 week or longer

4. How painful are your migraine headaches? (Circle one number)

1 2 3 4 5 6 7 8 9 10
Mild Severe

5. Where are your migraine headaches usually located? (Check all that apply)

□Behind right eye □behind left eye □behind both eyes

□Right temple □left temple □both temples
□Above right eyebrow □above left eyebrow □above both eyebrows
□Back of head on right □back of head on left □back of head on both sides

6. How old were you when your migraine headaches started?

7. How would you describe your migraine headaches? (Check all that apply)
□Throbbing/pounding □Ache/pressure □Like a tight band □Dull □Other

8. Do your migraine headaches awaken you at night?

□Never □Occasionally □Often

31
ANNEXURES CHAPTER7

9. Do any of the following occur before or during your migraine headaches? (Check all that apply)

□Nausea □Vomiting □Diarrhea

□Bothered by light/noise □Blurred/double vision □Sparkling, flashing, or colored lights
□Eyelid puffy □Eyelid droops □ Loss of vision

□Feeling lightheaded □Numbness / tingling □Weakness of arm or leg

□Difficulty concentrating □Speech difficulty □Loss of consciousness
□Runny nose Other

10. Do any of the following bring on your migraine headaches or make them worse? (Check all that apply)

□Stress (worry, anger) □Bright Sunshine □Weather change

□Letdown" after stress □Loud noise □Heavy lifting
□Air travel □Fatigue □Certain smells or perfume
□Missed meals □Sexual activity □Coughing, straining, bending over
□Certain foods (chocolate, cheese, beer, MSG) □Other

11. Do any of the following make your migraine headaches better?

□Rest □Exercise □Quiet and darkness

□Hot or cold compress □Massage □Warm shower
□Pressure over migraine headache area □Other

12. If you are female, do your migraine headaches change with the following? (Check all that apply)
□Menstrual periods □Birth control pills □Pregnancy □Other hormonal drugs

13. Do any of your family members have migraine headaches?

□No □Yes If "yes", explain (who):

14. Have you ever had a head or a neck injury requiring medical treatment?
□No □Yes If "yes", describe:

15. Have you ever been diagnosed to have any health disorder (e.g. high blood pressure, asthma, heart
disease, gastric ulcers)?
□No □Yes If "yes," please list:

16. Have you had your migraine headaches evaluated by a neurologist?

32
ANNEXURES CHAPTER7

□No □Yes If "yes", when, where, and by whom?

What was the diagnosis? (Check all that apply)

□Migraine □Tension-type □Cluster □Other, specify:

33
 Questionnaire

17. Have your migraines been treated with Botox?

□No □Yes If "yes", when, where, and by whom?

18. Did the Botox treatment work? □No □Yes If "yes," for how long:

19. What site was the Botox injected?

20. List all past tests you had for your migraine headaches:

21. List all past treatment(s) for your migraine headaches:

22. Are you taking any prescription drugs to treat your migraine headaches?
□No □Yes If "yes", list the medications:

How many times in the last month have you used the prescribed medications?

23. Are you taking any over-the-counter drugs to treat your migraine headaches?
□No □Yes If "yes," list the medications:

How many times in the last month have you used the over-the-counter
medications?

24. What is your estimated cost per month of your migraine headache medications and visits to
the physician?

25. How much of these medical expenses are covered by your health insurance?

34
 Questionnaire

26. How would you rate your general health in the last month? (Check one)
□Excellent □Good □Fair □Poor

27. To what extent do your migraine headaches affect your quality of life? (Check one)
□Extremely □Moderately □Very little □Not at all

35
 Chapter 7 Annexure

ANNEXURE D

GANTT CHART

RESPONSIBILITY
TASK TO BE (NAME OF JULY AUGUST SEPTEMBER OCTOBER NOVEMBER
COMPLETED RESEARCHER) (WEEKS) (WEEKS) (WEEKS) (WEEKS) (WEEKS)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
PROPOSAL
DRAFTING
AMMAR HUSSAIN
AND
APPROVEL
PRETEST AND
REFINEMENT
AMMAR HUSSAIN
OF
QUESTIONARE
DATA
COLLECTION AMMAR HUSSAIN

DATA ENTRY AMMAR HUSSAIN

RESULTS AND
AMMAR HUSSAIN
ANALYSIS
REPORT
AMMAR HUSSAIN
WRITING
PRINTING
AMMAR HUSSAIN
AND BINDING

SUBMISSION AMMAR HUSSAIN

36
Chapter 7 Annexure

ANNEXURE E

BUDGET CHART
S.NO CATEGORY COST IN PKR

1 TRANSPORT 300
2 PRINTING 2000
3 BINDING 500
4 MISCELLANIOUS 500
TOTAL 3300

37