A cross sectional study of tension headache among Ahlia University male students in the Kingdom of Bahrain - Thesis Example

? A cross sectional study of tension headache among Ahlia male in the Kingdom of Bahrain Chapter I Introduction In the past decade, the world faced great challenges in every facet of life. People’s lives are getting better every day because of globalization- better living conditions, better education, better communication and a lot more. Technology has become the mantra of this generation. Cyber technology has allowed people to access the world at their fingertips. No matter how comfortable life today is, we cannot deny the fact that more and more people are being stressed a lot. We now live in a fast-paced environment where people wake up early in the morning, start their day with a cup of coffee, and then rush off to school or work. Some even juggle work and school at the same time. Living through a day is one big headache. Sometimes, some detest getting up in the morning. No matter how convenient living in this century is, it does not always equal to happiness. There are events in one’s life that may cause one to be unhappy. These unpleasant events are one of the causes of tension headache. What is tension headache? Tension headache or tension-type headache is the most common type of chronic recurring head pain (Blanda). According to the International Headache Society, tension - type headache is the most common type of primary headache: its lifetime prevalence in the general population ranges in different studies from 30 to 78%. At the same time, it is the least studied of the primary headache disorders, despite the fact that it has the highest socio-economic impact. It can be further classified as episodic headache, chronic tension-type headache. Episodic headache lasts for a few minutes or days.  The pain is typically bilateral, pressing or tightening in quality and of mild to moderate intensity, and it does not worsen with routine physical activity. There is no nausea but photophobia or phonophobia may be present. On the other hand, chronic tension-type of headache is a disorder evolving from episodic tension-type headache, with daily or very frequent episodes of headache lasting minutes to days. The pain is typically bilateral, pressing or tightening in quality and of mild to moderate intensity, and it does not worsen with routine physical activity. There may be mild nausea, photophobia or phonophobia. According to Schwartz, Stewart, Simon and Lipton, tension-type headache is a highly prevalent condition. According to the University of Maryland Medical Center, tension headaches affects up to 78% of the general population. It is also the most neglected and undertreated type of headache. Tension – type headache has no specific cause. It is often triggered by emotional tension, anxiety, tiredness or stress. It can affect both young and old. Young students who seem to be healthy but have a lifestyle full of stress often put themselves at a very high risk for tension headaches. Treatment goals for tension headache usually includes analgesics and massage therapy. Through the help of evidenced - based practice, new approaches towards tension headache emerged. Physiotherapy has greatly contributed in the treatment of tension headaches. Despite the comfortable lifestyle that people have, the incidence of tension headache is increasing. There is evidence that biofeedback, yoga and relaxation techniques can help relieve pain and lower the number of headaches (University of Maryland Medical Center). This study focuses on the prevalence of tension headache across college departments as it relates to the difficulty of courses. Statement of the Problem This research aims to look into the relationship of course difficulty and the incidence of tension headache among the male students of Ahlia University in the Kingdom of Bahrain. Specifically, it seeks to answer the following questions: 1. What is the frequency of occurrence of tension headache among the respondents? 2. What is the common characteristic of pain among the respondents in terms of: a. Mild b. Moderate c. Severe 3. What is the duration of tension headache attacks? 4. What is the extent of medication dependency among the respondents? 5. Is there a direct relationship between frequency, intensity, duration and medication dependency and course difficulty among the respondents? 6. What are the implications of medication dependency and physiotherapy in dealing with tension headaches? Hypothesis There is no significant relationship between the frequency, intensity, duration and medical dependency of tension headache and course difficulty among the male students of Ahlia University in the Kingdom of Bahrain. Significance of Study The results of this study will provide a wide range of information on the relationship of tension headache and course difficulty among college students. It will also serve as a feedback regarding the effect of physiotherapy and ergonomics in treating tension headaches. Scope and Limitation of Study This study aimed to see the relationship of course difficulty and the incidence of tension headache among the male students of Ahlia University in the Kingdom of Bahrain. It did not include migraine and mixed headaches and female respondents. Chapter II Review of Related Literature and Studies Headache is defined by the International Headache Society as pain located above the orbitomeatal line. It can be symptoms of any condition of the head and neck. There are also types of headaches that can run in the family. There are several classifications of headache. According to the National Institute of Neurological Disorders and Stroke, there are two types of headache. Primary headaches occur independently and are not caused by another medical condition. This type of headache does not have a specific pathophysiology. It is said that it is caused by a series of events that affect blood vessels and nerves inside and outside the head; causes pain signals to be sent to the brain. Brain chemicals called neurotransmitters are involved in creating head pain, as are changes in nerve cell activity (called cortical spreading depression). Some of the classifications of headache under this are migraine, cluster, and tension-type headache. Secondary headaches are symptoms of another health disorder that causes pain-sensitive nerve endings to be pressed on or pulled or pushed out of place. This headache may arise from other conditions such as high fever, infection, hypertension, trauma and tumors among others. According to the World Health Organization, headache disorders are only partly documented but taken together, they are extraordinarily common. Migraine is the most studied type of headache but it is not a common type of headache disorder. Other types of headache, such as the more prevalent TTH and sub-types of the more disabling chronic daily headache, have received less attention. Few population-based studies exist for developing countries where limited funding and large and often rural populations, coupled with the low profile of headache disorders compared with other diseases, prevent the systematic collection of information (World Health Organization). Tension headaches, previously called muscle contraction headache, is the most common type of headache. Tension headaches can hurt anywhere around the head but, usually cause pain on both sides (Robbins and Lang, pp 142-143). Tension-type headaches may also be caused by jaw clenching, intense work, missed meals, depression, anxiety, or too little sleep. Tension headaches is characterized by mild to moderate pain and feels as if there’s a constant pressure being applied to the front of the face, head and neck. Tension headache usually occurs periodically and is mostly relieved by over the counter pain medications or rest. Depending on the frequency of occurrence, tension headaches can be classified as episodic or chronic (Robbins and Lang, p 143). Episodic tension headache occurs randomly and is usually triggered by temporary stress, anxiety, fatigue or anger. They are what most of us consider "stress headaches." It may disappear with the use of over-the-counter analgesics, withdrawal from the source of stress or a relatively brief period of relaxation (NHF). On the other hand, chronic tension headache occurs daily and continuous. The intensity of chronic tension headace varies during the 24 hour period. Chronic tension-type headache can also be the result of either anxiety or depression. Changes in sleep patterns or insomnia, early morning or late day occurrence of headache, feelings of guilt, weight loss, dizziness, poor concentration, ongoing fatigue and nausea commonly occur. One should seek professional diagnosis for proper treatment if these symptoms exist. Stress is the number one culprit in the occurrence of tension type headache. Tension headache is also often called stress headache (Total Headache relief). Headache attacks among college students were found to be widespread phenomenon that was affecting at least 45% of all students once per week, and 35–45% of the students experienced headache severe enough to disrupt planned activities according to a study conducted by Attanasio and Andrasik (pp 216-223). Earlier studies have shown that Asian have lower prevalence of migraine headache than Westerners. There are two surveys of chronic daily headache conducted in Taiwan, one in the general population and the other in the elderly population, have revealed prevalence rates (3.2% to 3.9%) similar to those of Western countries (3.0% to 4.7%) (Wang, pp104-108). There are several ways in treating occasional tension headaches. Relaxation techniques, cold compress and over the counter medication are the most common. In the recent years, studies have been focused on development of new treatment options including pharmaceutical developments. According to the National Institute of Neurological Disorders and strokes, results of three randomized, placebo-controlled clinical trials show the drug topiramate is effective, safe, and generally well-tolerated for treating chronic migraine. Experts agree that treatment with combinations of preventive agents offers maximum relief for the majority of individuals with chronic migraine. A NINDS-funded clinical trial is examining the effectiveness and safety of the drug propranolol combined with topiramate in reducing the frequency of chronic migraine in 250 participants who will be randomly selected to receive treatment with both drugs or topiramate and placebo. Most studies recently have focused on the non-pharmaceutical approach in treating tension headache. In a study conducted by Keller and Bzdek in 1986, they believe that therapeutic touch is a modern derivative of the laying on of hands that involves touching with the intent to help or heal. Their study investigated on the effects of therapeutic touch in comparison with a placebo simulation of therapeutic touch. An average 70% pain reduction was sustained over the 4 hours following TT, which was twice the average pain reduction following the placebo touch. Using a Wilcoxon rank sum test, this was statistically significant, p less than 0.01. this showed that therapeutic touch has a potential beyong a placebo effect in the treatment of tension headache. Researchers at the University of Granada have shown that a 30-minute massage improves the psychological and physiological states of patients with tension headaches within 24 hours (Toro-Velasco, Arroyo-Morales and Fernandez-de-las-Penas, pp 527-535). People who suffer from headache delay taking prescription medications when they sense a headache coming on, and some choose to avoid taking them altogether. For instance, one study found that approximately two thirds of migraineurs delayed or avoided taking prescription drugs due to concerns about their side effects, which include difficulty concentrating, dizziness, nausea, and sleepiness (Gallagher and Kunkel). If these side effects inhibit learning, then aggressively treating a migraine attack may not yield benefits in terms of human capital acquisition. In fact, it is possible that the relationship between migraine headache and educational attainment has become more pronounced in the years since the first wave of the Add Health was administered as migraine sufferers increasingly rely on prescription medications with side effects that are potentially as detrimental to learning as the pain and other symptoms they are intended to treat. Physiotherapy helps decrease headache attack frequency significantly. Findings from a study conducted solely for the purpose of finding out the therapeutic effect of physiotherapy on tension headaches showed that there was a 50% decrease in headache frequency following physiotherapy sessions (Torelli, Jenson and Olsen, pp 24-36). Synopsis The role of physical therapy was not recognized until the early 20th century. According to Dr Fernandez-de-las-Penas, there is a need to develop physical therapy programmes for patients with tension-type headaches. Despite the availability of reseraches and studies on physiotherpay and tension headaches, there were still conflicts and indiscriminate use of techniques. Chapter III Methodology A. Research Design This study focused on the relationship of course difficulty and incidence of tension headache among the male students of Ahlia University in the Kingdom of Bahrain. The descriptive approach will be used to examine the relationship of course difficulty and incidence of tension headache. Descriptive research is to study what it is. It aims to find out what prevails in the present condition as relationships, held opinions and beliefs, processes and effects to the developing trends. It also seeks to determine relationships between variable, explores causes of phenomena, test hypothesis, and develops generalizations, principles or theories based on its findings. B. Research Locale This was conducted in the different colleges of Ahlia University in the Kingdom of Bahrain. Ahlia University is a dynamic, modern university with high standards of teaching, international affiliation and a growing reputation as Bahrain's premier institution for private higher education. It is located in the heart of Bahrain in Manama Kingdom of Bahrain at the crossroads of the Gulf. C. Data Collection The data collection method used in this research study consisted of two sets of questionnaire and an interview. The first set of questionnaire identifies the demographic data of the respondents, frequency, intensity and duration of tension headache experienced. The second set of questionnaire identified the degree of dependence of respondents to medication. The questionnaires were pilot tested to students that does to belong to the target population. Their comments and suggestions were noted and used to improve the questionnaire were checked and validated by research authorities specializing in questionnaire development. D. Instrumentation The research instrument used in this research is the questionnaire. The questionnaire is a common tool for data gathering. Two sets of questionnaire were distributed to the respondents. The first questionnaire identified the frequency, intensity and duration of headaches experienced by the respondents. The second set of questionnaire identified the degree of dependency of the respondents to the medication when experiencing headache. This questionnaire used the Likert Scale. E. Data Gathering Procedure In order for the research to be complete, data were gathered in an orderly manner. The students were invited to participate in the study and signed a letter of consent. The structured and closed ended questionnaires were distributed among the chosen respondents. F. Statistical Treatment of Data The data gathered through the questionnaires were analyzed using a combination of descriptive and inferential statistics. Specifically, it utilized the following statistical treatments: The incidence of tension headache among the respondents was determined using the mean formula. X = ?xi N Where: X=score N=population Chapter IV Analysis and Interpretation 53 students were surveyed for this study. 37 students met the inclusion criteria. Out of the 37 students who responded, 57.50 % were business students, 22.5 % were IT students. PT students comes third with 12.5 % respondents and Engineering students were the least with 7.5 % Table 4.1 Distribution of Respondents according to Course Course Frequency Percentage Business 21 57.5 % Engineering 3 7.5 % IT 8 22.5 % PT 5 12.5 % Total 100% The table below shows that almost all respondents suffered headache regardless of the course they are taking. All engineering and PT respondents had experienced headache. This means that headache is a common experience to college students, regardless of the difficulty of the course they are taking. The duration and degree of pain of headache attacks were described in Tables 4.3 and 4.4. Table 4.2 Frequency of occurrence of tension headache Course Mean Business 0.9 Engineering 1 IT 0.9 PT 1 Table 4.3 Average number of headache days per month Number of days Business Engineering IT PT 1 day 0.391 0.33 0.556 0.2 1-6 days 0.522 0.667 0.444 0.6 7-14 days 0.087 0 0 0.2 Table 4.4 Degree of pain College Mild Moderate Severe Mean Percentage Mean Percentage Mean Percentage Business 0.478 52.38% 0.478 52.38% 0.043 4.76% Engineering 0 0 0.667 66.7% 0.333 33.3 % IT 0.556 62.5% 0.333 37.50% 0.111 12.50% PT 0.4 40.00 % 0.6 60.00% 0 0 Respondents from the Business, IT and PT courses classify their headache pain as mild while engineering respondents classify their pain as moderate. Engineering students had describe their pain as moderate which means that though all respondents experience pain, engineering students experience intense pain as compared to other courses. Almost all engineering students stated that their headache inhibits them from performing activities of daily living. They also experience more often than the other college students as shown in Table 4.3. Overall, 56.76 % of all respondents suffer from headache at least once or twice a week. Table 4.5 Length of headache attack Length Business Engineering IT PT 4 h 0.696 0.33 0.667 0.6 4 h- 1 day 0.174 0.667 0.222 0.4 1- 3 days 0.087 0 0.111 0 3 days 0.043 0 0 0 Business, IT and PT respondents suffer headache attacks only up to 4 hours while Engineering students suffer headache almost the whole day. The prevalence of long duration tension headache (longer than 4 hours) in this study is 32.5 %. Table 4.6 Characteristics of Headache pain Characteristic Business Engineering IT PT Pulsating 0.13 0 0.5 0.6 Pressing 0.652 1 0.556 0.8 One-sided 0 0 0 0 Getting Worse 0.522 0.667 1 0.8 Nausea 0 0 0 0 Increased sensitivity 0.348 0.667 0.444 0.2 Business respondents characterize their headache as pressing and getting worse, while in the Engineering students, described attacks as getting worse and increased sensitivity. IT students have described headache attacks as pulsating and pressing and respondents from the PT department described pain as pressing and getting worse. Table 4.7 Aura before headache Business Engineering IT PT Visual disturbance 0.043 0 0 0 Sensory symptoms 0.043 0 0 0 Aura symptoms are symptoms felt before the onset of headache. It is a warning sign that usually lasts 5-60 minutes, usually about 20 minutes. Only one of the business respondents experienced aura before the headache. Table 4.8 Number of absences because of headache Course Mean Business 0.2 Engineering 1.3 IT 0.8 PT 0 Headaches interfere with activities of daily living. Respondents from the engineering department had incurred the most number of absences due to headache. In table 4.4, it was discussed that respondents described engineering students described headache pain as moderate intensity thus inhibiting them to attend to their classes at times. Students from the PT department had zero case of absenteeism, which can be associated with their knowledge of physiotherapy. Table 4.9 Mean Scores of medication dependency of respondents Questions Business Engineering IT PT 1. Do you have to take analgesics or migraine attack treatments almost every day to avoid getting a headache? 2.2 1 3 1.8 2. Do you frequently worry about how you will obtain your analgesics or migraine attack treatment, e.g., finding a pharmacy which is open, finding a doctor who will see you quickly? 2.1 1 1.5 1 3. Do your headaches re-appear or get worse when you space out the moments at which you take analgesics or migraine attack treatments or when you stop taking them? 2.2 1 4.5 1.4 4. Do you increase the number of intake of analgesics or migraine attack treatments more than the doctor recommended you? 1.7 1 5 1 5. Have you noticed that you have to take larger and larger quantities of analgesics or migraine attack treatments to obtain the same effects as before? 2 1 3.5 1.8 6. Have you ever tried to slow down on your consumption of analgesics or migraine attack treatments but not succeeded in doing so? 2.4 1 2 1 7. In your opinion, do you really take too many analgesics or migraine attack treatments? 2.1 1 1 1.6 8. Are you taking a higher dose of analgesics or migraine attack treatments than your doctor recommended you to take? 1.5 1 3 1 9. Does the use of analgesics or migraine attack treatments stop you from doing some of your daily tasks at work or at home? 1.5 1 1.5 1.4 10. Do you frequently happen to use several sorts of analgesics or migraine attack treatments on the same day? 1.9 1 2 1 11. Do you ever feel bad (physical or psychological feeling) whenever you have not taken analgesics or migraine attack treatments for a longer period than normal? 2.2 1 1 2.4 12. Do you frequently waste time because you want to get hold of some analgesics or migraine attack treatments, e.g., queuing at the doctor or at the pharmacist’s, going to see several doctors, etc.? 2 4.7 2.5 1 13. Do you think that it is very important to manage to decrease your consumption of analgesic or migraine attack treatments? 2.8 5 2 2.8 14. Do you ever take analgesics or migraine attack treatments for symptoms other than headache, e.g., tiredness, nervous tension? 2.6 1 3.5 2.2 15. Do you get the impression that analgesics or migraine attack treatments are becoming less and less efficient for your headaches? 2.1 5 4.5 3 16. Do you continue to take lots of analgesics or migraine attack treatments even though you know it is harmful for your health? 1.9 3.7 2.5 1.8 17. Have you ever had trouble in your activities of daily life (domestic activities, professional work, looking after the children) because of the side effects of analgesic or migraine attack treatments? 2.2 5 4 1.4 18.Do you continue to take as many analgesics or migraine attack treatments despite somebody close to you telling you that you seem to be intoxicated by them? 1.7 1.7 2 1 19. Do you often waste time because you are under the effect of analgesics or migraine attack treatments? 2 3.7 3 2.2 20. Are you ever bothered in your social or family relationships because of the effects of analgesics or migraine attack treatments? 1.8 2 1 1.8 21. Do you continue to take as many analgesics or migraine attack treatments even though you know that it might worsen your headache? 2.1 1 1.5 1.2 Mean 2.05 2.08 2.59 1.61 From the above table it can be gleaned that respondents from the Business, Engineering and IT Courses takes medication sometimes or little medication dependency when suffering from head ache, while respondents from the PT course, never or not at all take medication when they have headache. Thus, it can be concluded that even with moderate intensity of headache, students still avoid pain medication. The total mean score for each department ranged from 1.61 to 2.59. In the Likert Scale used in this study, 1 means “Never or Not at all”. PT students have the lowest incidence of medication dependence with a mean score of 1.61. This can be associated with their knowledge of physiotherapy techniques that could aid their pain before it gets worse. Chapter V Summary and Conclusion Headache is the most common symptom that every person experience at least once in their life. Headache attacks can make a simple task impossible to perform. This study aimed to see the relationship of course difficulty and occurrence of tension headache. Structured and closed ended questionnaires were distributed to the participants. All respondents have experienced at least once in the last three months and almost all expect for the Engineering students experienced headache attacks in brief periods. Engineering students presented moderate intensity of headache pain and the attack is longer in duration as compared to other respondents taking other courses. In conclusion, this study presents the occurrence of tension headache among the male college students of Ahlia University in the Kingdom of Bahrain. Physiotherapy, alongside with ergonomics can help prevent the effects of headache such as absenteeism. Ergonomics the science related to man and his work, embodying the anatomic, physiologic, and mechanical principles affecting the efficient use of human energy (Inverarity). Findings showed that there is a relationship between course difficulty and occurrence of headache. Overall, engineering students have presented moderate intensity of pain and incurred the most number of absences while PT students the least number of absences due to headache. It is necessary that basic physiotherapy and ergonomics be taught to the students in order to prevent debilitating consequences of tension headache particularly with the scholastic performance. APPENDICES Appendix A Intensity of Pain Duration of Pain Medication Dependency Bibliography Attanasio, V. and F. Andrasik. "Further Examination of Headache in a College Student Population." Headache: The Journal of Head and Face Pain 27.4 (1987): 216-223. Blanda, M. Medscape Reference. April 2011. 3 May 2011 . Foundation, National Headache. "National Headache Foundation." 2011. National Headache Foundation. 3 May 2011 . Inverarity, L. "Ergonomics." December 2004. About.com. 3 May 2011 . Robbins, L. and S. Lang. Headache Help: A Complete Guide to Understanding Headaches and the Medications That Relieve Them. New York: Houghton Mifflin Company, 2000. Torelli, P., R. Jenson and J. Olsen. "Physiotherapy for tension-Type Headache: A Controlled Study." Cephalalgia 24 (2004): 29-36. Toro-Velasco, C., et al. "Short-Term Effects of Manual Therapy on Heart Rate Variability, Mood State, and Pressure Pain Sensitivity in Patients With Chronic Tension-Type Headache: A Pilot Study." Jornal of Manipulative and Physiological Therapeutics 32.7 (2009): 527-535. Total Headache relief. 3 May 2011 . University of Maryland Medical Center. 3 May 2011 . Wang, S. "Epidemiology of migraine and other types of headache in Asia." Current Neurology and Neuroscience Reports 3.2 (2003): 104-108. "World Health Organization." March 2004. WHO Media Centre. 2011 3 May . Read More