A prevalência de cefaleia e fatores psicossociais associados em estudantes de medicina no Ceará / The prevalence of headache and psychosocial factors associated among medical students in a university of northeast Brazil

Introdução: A cefaleia é uma afecção que impacta negativamente a qualidade de vida da pessoa. O curso de medicina é reconhecidamente um gerador de esgotamento e, de acordo com a literatura, fatores estressantes são mais comuns em alunos de medicina que na população em geral, podendo desencadear a cefaleia. Esses fatores estressores podem ser intensificados em períodos que antecedem as provas devido a mudanças nos hábitos de sono e de estudo, havendo uma possível relação com o surgimento de cefaleias primárias. Objetivo: Avaliar a prevalência de cefaleia primária nos estudantes de medicina (EM) em períodos de provas e relacionar com fatores psicossociais. Métodos: Trata-se de um estudo transversal, baseado na aplicação de dois questionários a uma amostra de 219 EM do 1º ao 8º semestre de uma universidade no interior do Ceará. Um questionário relacionou a cefaleia com fatores psicossociais em períodos de provas. O segundo questionário: HSQ-DV, foi utilizado para o diagnóstico de enxaqueca e cefaleia do tipo tensional (CTT). Resultados: 98% dos EM relataram já ter sentido cefaleia. A prevalência de CTT e enxaqueca encontradas foi de 61,9% e 18,1%, respectivamente, dados maiores que a média para a população geral. Estudantes com enxaqueca têm mais crises antes de provas, se automedicam mais, ingerem mais psicoestimulantes, são mais ansiosos, mais depressivos, mais sedentários, mais estressados e dormem menos que aqueles com CTT. Conclusão: De fato, os EM são um grupo de risco para o desenvolvimento de cefaleias, merecendo, portanto, uma maior ênfase de pesquisas científicas sobre as cefaleias primárias neste grupo.

Introduction: Headache is a condition that impacts negatively the patients' quality of life. The medical course is a known generator of exhaustion and, according to the literature, stressors are more common in medical students (MS) than in the general population, which can trigger a headache. These stressors can be intensified in periods that precede the tests due to changes in sleep and in study habits, with a possible relation with the appearance of primary headache. Objective: To associate the presence of primary headache in MS during periods of tests and to relate to psychosocial factors. Methods: This is a cross-sectional study based on the application of two questionnaires to a sample of 219 MS from the 1st to the 8th semester of a university in Northeast Brazil. The first questionnaire related headache with psychosocial factors in periods of tests. The second questionnaire: HSQ-DV, was used for the diagnosis of migraine and tension-type headache (TTH). Results: 98% of MS reported having experienced headache. The prevalence of TTH and migraine was 61.9% and 18.1%, respectively, higher than the average for the general population. Students with migraine have more attacks before tests, self-medicate more, ingest more psychostimulants, are more anxious, more depressed, more sedentary, more stressed, and sleep less than those with TTH. Conclusion: In fact, MS are a risk group for the development of headache, thus deserving a greater emphasis of scientific research on primary headaches in this group

Factors Associated with Primary Headache According to Diagnosis, Sex, and Social Group.

BACKGROUND: We previously showed that migraine and tension-type headache (TTH) have a high prevalence that differs markedly between social groups. Here, we aim to identify factors associated with migraine and TTH (possible risk factors) in three social groups to better understand the difference in prevalence between sexes, between different headache diagnoses, and between different social groups. MATERIAL AND METHODS: The study included 3124 persons: 1007 blood donors (484 females, mean age 34.1), 1075 workers in an oil and gas factory (146 females, mean age 40.4), and 1042 medical students (719 females, mean age 20.6). Headache diagnoses and associated factors were identified by direct or telephone interview using a semistructured, validated form. It was administered by a neurologist or by specially trained senior medical students under supervision of a neurologist. RESULTS: We report factors associated with headache according to diagnosis, sex, and social group using multivariate logistic regression analysis. (1) According to diagnosis. Many associated factors were common for migraine and TTH: female sex, arterial hypertension, history of head trauma, and consumption of light alcoholic beverages. To be a student was associated with the highest risk of migraine (OR 6.6; 95% CI 4.2-10.4) and TTH (OR 3.6; 95% СI 2.7-4.8). Low physical activity (OR 1.6; 95% CI 1.0-2.4) and family history of headache (OR 2.1; 95% CI 1.5-2.9) were associated only with migraine. Current smoking and BMI > 25 were negatively associated with migraine and TTH. (2) According to sex. Common factors associated with migraine and TTH in both sexes included history of head trauma, family history of headache, and arterial hypertension. Use of alcohol was different between sexes: in males consumption of strong alcoholic beverages was associated with TTH (OR 1.5; 95% CI 1.0-2.0) and in females consumption of light alcoholic beverages was associated with migraine (OR 3.49; 2.03-6.02) and TTH (OR 3.0; 95% CI 1.93-4.66). Low physical activity was associated with migraine in females (OR 1.9; 95% CI 1.1-3.2). (3) According to social group. Common factors associated with headache in all groups included female sex, family history of headache, history of head trauma, and arterial hypertension. Consumption of light alcoholic beverages was associated with migraine and TTH in blood donors and students. Only two factors were specific to a social group: consumption of strong alcoholic beverages was associated with TTH in blood donors (OR 1.5; 95% CI 1.1-2.1), low physical activity was associated with migraine in students (OR 1.98; 95% CI 1.04-3.74) and with TTH in workers (OR 2.1; 95% CI 1.2-3.7). CONCLUSION: Most of the associated factors were shared by the sexes. The associated factors varied somewhat more between migraine and TTH and between social groups. To be a student was associated with the highest risk of headache. Factors different from those in the present and previous studies should be studied in the future in order to better understand the differences in associated factors according to diagnosis, sex, and social group.