Introduction: Headache is a common problem among young adults and a major source of disability. Students in health-related programs are particularly exposed to academic and psychosocial demands that may promote its occurrence and impact. Objective: To determine the prevalence and characteristics of headache among students of the paramedical schools of Dapaong and to identify factors associated with its presence and its substantial impact. Methods: A descriptive and analytical cross-sectional study was conducted from January 22 to March 6, 2026, among students of the paramedical schools of Dapaong (Northern Togo). Data were collected through a self-administered electronic questionnaire on KoboToolbox after informed consent. Headache was defined by its presence during the six months preceding the survey, and its typology was assigned algorithmically from self-reported features using operational criteria based on the ICHD-3. Impact was assessed with the HIT-6. Factors associated with the presence of headache and then with its substantial impact were examined using bivariate and multivariate analyses. Analyses were performed with R version 4.5.3. Results: Of the 192 students invited, 118 questionnaires were collected and 117 analyzed. Headache affected 82/117 (70.1%) participants. Among those with headache, tension-type headache was the most frequent category (32/82; 39.0%, 95% CI 28.4 to 50.4); migraine affected 19/82 (23.2%, 95% CI 14.6 to 33.8), corresponding to a prevalence of 16.2% (95% CI 10.1 to 24.2) in the overall sample. Anxiety was independently associated with the presence of headache (aOR 1.66; 95% CI 1.20 - 2.30; p = 0.002). Substantial impact (HIT-6 ≥ 56) affected 40/82 (48.8%, 95% CI 37.6 to 60.1) of participants with headache and was independently associated with pain intensity (aOR 1.53; 95% CI 1.21 - 2.02; p < 0.001) and perceived stress (aOR 1.19; 95% CI 1.06 - 1.37; p = 0.006). Conclusion: Headache is very common among students of the paramedical schools of Dapaong. Its presence is independently associated with anxiety symptoms, whereas its substantial impact is associated with pain intensity and perceived stress.
References
[1]
GBD 2016 Headache Collaborators (2018) Global, Regional, and National Burden of Migraine and Tension-Type Headache, 1990-2016. The Lancet Neurology, 17, 954-976.
[2]
Woldeamanuel, Y.W. and Cowan, R.P. (2017) Migraine Affects 1 in 10 People Worldwide Featuring Recent Rise: A Systematic Review and Meta-Analysis of Community-Based Studies Involving 6 Million Participants. Journal of the Neurological Sciences, 372, 307-315. https://doi.org/10.1016/j.jns.2016.11.071
[3]
Steiner, T.J., Stovner, L.J., Jensen, R., Uluduz, D. and Katsarava, Z. (2020) Migraine Remains Second among the World’s Causes of Disability, and First among Young Women: Findings from GBD2019. The Journal of Headache and Pain, 21, Article No. 137. https://doi.org/10.1186/s10194-020-01208-0
[4]
Wang, X., Zhou, H.B., Sun, J.M., Xing, Y.H., Zhu, Y.L. and Zhao, Y.S. (2015) The Prevalence of Migraine in University Students: A Systematic Review and Meta‐Analysis. European Journal of Neurology, 23, 464-475. https://doi.org/10.1111/ene.12784
[5]
Flynn, O., Fullen, B.M. and Blake, C. (2022) Migraine in University Students: A Systematic Review and Meta‐Analysis. European Journal of Pain, 27, 14-43. https://doi.org/10.1002/ejp.2047
[6]
Abtahi, S., Esfahanian, F., Akbari, M., Roomizadeh, P. and Neshat, S. (2023) Headache—A Challenge across Medical Students’ Life: A Systematic Review and Meta-Analysis. Acta Neurologica Belgica, 123, 785-801. https://doi.org/10.1007/s13760-023-02274-2
[7]
Jahrami, H., AlKaabi, J., Trabelsi, K., Pandi-Perumal, S.R., Saif, Z., Seeman, M.V., et al. (2023) The Worldwide Prevalence of Self-Reported Psychological and Behavioral Symptoms in Medical Students: An Umbrella Review and Meta-Analysis of Meta-Analyses. Journal of Psychosomatic Research, 173, Article ID: 111479. https://doi.org/10.1016/j.jpsychores.2023.111479
[8]
Binjabr, M.A., Alalawi, I.S., Alzahrani, R.A., Albalawi, O.S., Hamzah, R.H., Ibrahim, Y.S., et al. (2023) The Worldwide Prevalence of Sleep Problems among Medical Students by Problem, Country, and COVID-19 Status: A Systematic Review, Meta-Analysis, and Meta-Regression of 109 Studies Involving 59427 Participants. Current Sleep Medicine Reports, 9, 161-179. https://doi.org/10.1007/s40675-023-00258-5
[9]
Woldeamanuel, Y.W., Andreou, A.P. and Cowan, R.P. (2014) Prevalence of Migraine Headache and Its Weight on Neurological Burden in Africa: A 43-Year Systematic Review and Meta-Analysis of Community-Based Studies. Journal of the Neurological Sciences, 342, 1-15. https://doi.org/10.1016/j.jns.2014.04.019
[10]
Kosinski, M., Bayliss, M.S., Bjorner, J.B., Ware, J.E., Garber, W.H., Batenhorst, A., et al. (2003) A Six-Item Short-Form Survey for Measuring Headache Impact: The Hit-6？. Quality of Life Research, 12, 963-974. https://doi.org/10.1023/a:1026119331193
[11]
Yang, M., Rendas-Baum, R., Varon, S.F. and Kosinski, M. (2010) Validation of the Headache Impact Test (HIT-6？) across Episodic and Chronic Migraine. Cephalalgia, 31, 357-367. https://doi.org/10.1177/0333102410379890
[12]
Stewart, W.F., Lipton, R.B., Dowson, A.J. and Sawyer, J. (2001) Development and Testing of the Migraine Disability Assessment (MIDAS) Questionnaire to Assess Headache-Related Disability. Neurology, 56, S20-S28. https://doi.org/10.1212/wnl.56.suppl_1.s20
[13]
von Elm, E., Altman, D.G., Egger, M., Pocock, S.J., G？tzsche, P.C. and Vandenbroucke, J.P. (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies. The Lancet, 370, 1453-1457. https://doi.org/10.1016/s0140-6736(07)61602-x
[14]
Cohen, S., Kamarck, T. and Mermelstein, R. (1983) A Global Measure of Perceived Stress. Journal of Health and Social Behavior, 24, 385-396. https://doi.org/10.2307/2136404
[15]
Kroenke, K., Spitzer, R.L., Williams, J.B.W., Monahan, P.O. and L？we, B. (2007) Anxiety Disorders in Primary Care: Prevalence, Impairment, Comorbidity, and Detection. Annals of Internal Medicine, 146, 317-325. https://doi.org/10.7326/0003-4819-146-5-200703060-00004
[16]
Kroenke, K., Spitzer, R.L. and Williams, J.B.W. (2003) The Patient Health Questionnaire-2. Medical Care, 41, 1284-1292. https://doi.org/10.1097/01.mlr.0000093487.78664.3c
[17]
Stewart, W., Lipton, R., Kolodner, K., Liberman, J. and Sawyer, J. (1999) Reliability of the Migraine Disability Assessment Score in a Population-Based Sample of Headache Sufferers. Cephalalgia, 19, 107-114. https://doi.org/10.1046/j.1468-2982.1999.019002107.x
[18]
Headache Classification Committee of the International Headache Society (2018) The International Classification of Headache Disorders, 3rd Edition. Cephalalgia, 38, 1-211.
[19]
Steiner, T.J., Gururaj, G., Andrée, C., Katsarava, Z., Ayzenberg, I., Yu, S., et al. (2014) Diagnosis, Prevalence Estimation and Burden Measurement in Population Surveys of Headache: Presenting the HARDSHIP Questionnaire. The Journal of Headache and Pain, 15, Article No. 3. https://doi.org/10.1186/1129-2377-15-3
[20]
Shapiro, S.S. and Wilk, M.B. (1965) An Analysis of Variance Test for Normality (Complete Samples). Biometrika, 52, 591-611. https://doi.org/10.1093/biomet/52.3-4.591
[21]
Clopper, C.J. and Pearson, E.S. (1934) The Use of Confidence or Fiducial Limits Illustrated in the Case of the Binomial. Biometrika, 26, 404-413. https://doi.org/10.1093/biomet/26.4.404
[22]
Peduzzi, P., Concato, J., Kemper, E., Holford, T.R. and Feinstein, A.R. (1996) A Simulation Study of the Number of Events per Variable in Logistic Regression Analysis. Journal of Clinical Epidemiology, 49, 1373-1379. https://doi.org/10.1016/s0895-4356(96)00236-3
[23]
Hosmer, D.W., Lemeshow, S. and Sturdivant, R.X. (2013) Applied Logistic Regression. 3rd Edition, Wiley. https://doi.org/10.1002/9781118548387
[24]
Nicholson, R.A., Houle, T.T., Rhudy, J.L. and Norton, P.J. (2007) Psychological Risk Factors in Headache. Headache: The Journal of Head and Face Pain, 47, 413-426. https://doi.org/10.1111/j.1526-4610.2006.00716.x
