Epidemiological studies regarding headache are abundant in developed countries; however, the data in developing countries are scarce. This study aims to detect the prevalence and clinical features of headache in Gaziosmanpasa University students in Tokat, Turkey.

Patients and methods
2168 subjects were selected with randomized stratified sampling, and 92.5% of them participated in the study (2023 students). Two neurologists from our medical faculty interviewed and examined the students with headache. Assessment was done according to The International Classification of Headache Disorders, 2nd edition.

Results
In our study, 22.64% of the students had tension-type headache (TTH), 17.89% had migraine headache, 0.29% TTH plus migraine headache, 0.20% had cluster and variants type of headache. Migraine type of headache was more common in females than in males (p = 0.0001); however, no significant difference was present between males and females who had migraine with aura and tension-type headache.

Discussion

The clinical features of tension-type headache and migraine in our university students were similar to the ones of general population and to the studies conducted on university students.

Introduction
Headache is one of the most common complaints encountered in pediatric and adult neurology clinics. Vast majority of the headaches are migraine and tension-type. While they can be mild and at infrequent intervals, they can also be severe and enduring. Severe and frequent headache limits the daily activities of life, decreases the quality of life and can result in the loss of productivity.

Epidemiological studies of headache help us to understand the frequency and nature of the headache and the factors that influence it. They help us to improve our knowledge about the mechanism of headache, its clinical features and management protocols. It will also support us with knowledge about functional disability caused by headache, its health cost and associated economical burden [1].

Epidemiological studies regarding headache are abundant in developed countries; however the data in developing countries are scarce. Also, the data encountered from the studies both in developing and in underdeveloped countries are very different in nature. These differences can be attributed to the methodology performed, to the age and gender of the study population, or to ethnical and cultural features of society or to the combination of these factors. This variability necessitates the need for headache prevalence studies in selected populations. We have assessed the prevalence and clinical features of headache in Gaziosmanpasa University students in Tokat, Turkey. The first study is investigated according to the second edition criteria and contains all primary headaches.

Materials and methods

The study was conducted on students attending to 24 departments of 6 faculties at Gaziosmanpasa University in Tokat, Turkey. A total of 7964 students (3020 female and 4944 male) are studying at this University. 2168 subjects were selected with randomized stratified sampling, and 92.5% of them participated in the study (2023 students). Students who were selected for this study, who had any kind of headache. In the first step, a socio-demographical form regarding their department, age, gender, the number of their siblings, their parents’ profession were handed out. They were also questioned about their headache complaints. In the second step, two neurologists from our medical faculty interviewed and examined the students with headache. Assessment was done using International Headache Society (IHS) 2004 criteria [2]. While the clinical properties of headache were studied, patients diagnosed with strict and probable migraine were pooled for the present analysis. Recent epidemiology data show that probable migraine greatly resembles strict migraine and suggest that both types of migraine are parts of the same spectrum of disease and differ more in degree than in kind [3] and [4]. Patients diagnosed with TTH and migraine headache were not evaluated for this present analysis. Because the patients with TTH and migraine headache (n = 6) and with cluster headache (n = 4) had a very small of observed counts and so disturbed homogeneity. Thus they were not evaluated as a separate group. Moreover, as patients with TTH and migraine headache had characteristics peculiar to both groups, they were not included in TTH groups, either.

During this interview, students were questioned about the beginning age of the headache, its severity, nature and about its duration. They were also asked to describe the factors that aggravated or diminished the headache and the symptoms that accompanied it, and whether they did or did not take medications. In 12 students with chronic headache the use of potential drugs of abuse was present.

Conclusion

Our prevalence for tension-type headache and for migraine headache has a median value when compared with the previously reported studies conducted on university students. Comparisons were made according to IHS 1988 criteria although we diagnosed according to the second edition criteria. This second edition has not changed the major principles of classification and the diagnosis of primary headache disorders. Therefore, the existing body of evidence gained using the first edition remains valid for most diagnoses made using the second edition [2]. The clinical features of tension-type headache and migraine in our university students were similar to the ones of general population and to the studies conducted on university students. Studies with more subject participation are needed to confirm and settle about this issue.

References

[1] A. Siva, Baş Ağrısı Epidemiyolojisi, Türkiye Klinikleri Nöroloji Dergisi 1 (2) (2003), pp. 94–97.

[2] Headache Classification Committee of the International Headache Society, The international classification of headache disorders, second ed., Cephalalgia 24 (Suppl. 1) (2004), pp. 9–160.

[3] N.V. Patel, M.E. Bigal, K.B. Kolodner, C. Leotta, J.E. Lafata and R.B. Lipton, Prevalence and impact of migraine and probable migraine in a health plan, Neurology 63 (2004), pp. 1432–1438.

[4] C. Lucas, G. G’eraud, D. Valade, M.H. Chautard and M. Lanteri-Minet, Recognition and Therapeutic Management of Migraine in 2004 in France: Results of FRAMIG 3 a French Nationwide Population-Based Survey, Headache (2006), pp. 715–725.

[5] P. Henry, J.P. Auray, A.F. Gaudin, J.F. Dartigues, G. Duru and M. Lanteri-Minet et al., Prevalence and clinical characteristics of migraine in France, Neurology 59 (2) (2002), pp. 232–237.

[6] H. Kececi and S. Dener, Epidemiological and clinical characteristics of migraine in Sivas, Turkey, Headache 42 (4) (2002), pp. 275–280.

[7] A. Ozge, R. Bugdayci, T. Sasmaz, H. Kaleagasi, O. Kurt and A. Karakelle et al., The sensitivity and specificity of the case definition criteria in diagnosis of headache: a school-based epidemiological study of 5562 children in Mersin, Cephalalgia 23 (2) (2003), pp. 138–145.

[8] R. Zivadinov, K. Willheim, A. Jurjevic, D. Sepic-Grahovac, M. Bucuk and M. Zorzon, Prevalence of migraine in Croatia: a population-based survey, Headache 41 (8) (2001), pp. 805–812.

Keywords: Headache; Prevalence; Clinical characteristics; University students; Turkey

Semiha Kurt and Yuksel Kaplan

Gaziosmanpasa University Faculty of Medicine, Department of Neurology, 60100 Tokat, Turkey
Received 5 March 2007;  revised 8 August 2007;  accepted 9 September 2007.  Available online 23 October 2007.