Prevalence, Characteristics, and Treatment Pattern of Menstrual-Related Headache Among Undergraduate Health Sciences Students at Addis Ababa University, Ethiopia

Figures & data

Table 1 ICHD-III Criteria to Classify Headache Type

Pure menstrual migraine	Have migraine attacks occurring only during a 5-day menstrual period (days−2 to+3 of menstruation) in at least two of every three menstrual cycles and at no other times of the cycle
Menstrual related migraine	Have migraine attacks in a 5-day menstrual period (days−2 to+3 of menstruation) in at least two of every three menstrual cycles and additionally at other times of the month outside the cycle
Menstrual related headache	A common class of headaches that occur in women related to a decline in estrogen during the menstrual cycle

Table 2 Sociodemographic Characteristics of the Study Participants (N=757)

Variables	Frequency	Percentage
Age category
Less 20	48	6.3
20–25	664	87.7
25–30	42	5.5
Greater 30	3	0.4
Marital status
Single	713	94.2
Married	44	5.8
Field of study
Medicine	263	34.7
Pharmacy	176	23.2
Dental medicine	91	1.8
Radiology	67	6.3
Anesthesia	53	5.9
Medical laboratory	48	8.9
Nursing	45	12
Midwifery	14	7
Year of study
Year I	16	2.1
Year II	151	19.9
Year III	217	28.7
Year IV	199	26.3
Year V	126	16.6
Year VI	48	6.3

Table 3 Prevalence and Characteristics of MRH Among Participants

	Frequency	Percentage
Lifetime headache experience
Menstrual related headache	86	11.4
Non-menstrual related	671	88.6
Types of MRH
Tension-type	36	42
Migraine	19	22.5
Cluster headache	8	9.3
Unclassifiable	23	26.7
Headache frequency since last year
Three times/month	337	44.5
Once/month	225	29.7
One-two/six months	132	17.4
Once/week	46	6.1
One-two /year	17	2.2
Menstrual cycle for MRH
Regular (21–35 days)	75	87.2
Irregular (>35 days)	11	12.8
Family history of MRH
Yes	51	59.3
No	35	40.7
Recurrence of MRH
Yes	25	29.1
No	61	70.9
Time of MRH began
2–3 days before menses	28	32.6
During menses	48	55.8
2–3 days after menses	10	11.6
Duration of MRH without taking medication
1–4 hours	39	45.3
4–12 hours	25	29.1
12–24 hours	10	11.6
24–72 hours	9	10.5
>72 hours	3	3.5
Frequency of MRH
>1/3 cycle	25	29.1
Every other cycle	34	39.5
Every cycle	27	31.4
Associated symptoms
Nausea and vomiting	28	32.6
Photophobia	20	23.3
Dizziness	16	18.6
Phonophobia	12	14
Appetite loss	10	11.6
Headache location
Bilateral	66	76.7
Unilateral	20	23.3
Headache quality
Dull type pain	34	39.5
Sharp stabbing/throbbing/	26	30.2
Pulsative	26	30.2
Pain severity
Mild pain	26	30.2
Moderate pain	25	29.0
Severe pain	18	20.9
Triggering factors for MRH
Menstrual period	56	65.1
Sleep disturbance	20	23.3
Exam stress	8	9.3
Strong odor	2	2.3

Table 4 Burden of MRH Among Undergraduate Female Students

Items Description	Mean ±SD (days)	Median number of missed days
Days of missed school/work	1.24±1.53	1 (0–6)
Days of reduced productivity (work/school) within three months	3.41±2.07	3 (0–8)
Days of missed household work within three months	2.21± 2.06	3 (0–6)
Days of reduced productivity (household work) by half or more within three months	3.16±3.55	2 (0–15)
Days of missed social activities within three months	1.91±2.99	1 (0–15)

Table 5 Treatment Pattern of MRH Among Undergraduate Female Students (N=86)

Variables	Frequency	Percentage
Got medical consultation
Yes	45	52.3
No	41	47.7
Consulted professionals
Pharmacists	16	39.0
Doctors	25	61.0
Treatment taken
Take medication available at home	31	36.0
Purchase analgesics from the pharmacy	33	38.4
Do not take anything	18	20.9
Take herbal medicine at home	4	4.7
Analgesic relieved the pain
Yes	74	86.0
No	12	14.0
Analgesic medication taken
Ibuprofen	40	54.8
Paracetamol	26	35.6
Diclofenac	3	4.1
Panadol-extra (paracetamol + caffeine)	2	2.7
Sumatriptan	2	2.7
Non-pharmacologic treatment
Sleeping in a quiet environment	68	79.1
Avoiding light	14	16.3
Taking coffee	4	4.7

Table 6 Factors Associated with MRH Pain Severity Among the Participants

Variables	Category	Headache		COR (95% CI)	AOR (95% CI)	p-value
		MRH	Non-MRH
Age in years	<20 years	12	36	1	1
	20–25 years	69	594	2.87 (1.43–5.77)	2.24 (0.91–5.49)	0.080
	25–30 years	3	40	4.44 (1.16–17.02)	4.96 (0.96–25.56)	0.055
	>30 years	2	1	0.17 (0.01–2.01)	0.22 (0.01–3.42)	0.281
Marital Status	Married	16	28	1	1
	Single	70	643	5.25 (2.71–10.18)	6.24 (2.73–14.26)	0.000*
Family monthly income (ETB)	<15,000	35	134	1	1
	15,000–30,000	13	223	4.48 (2.29–8.77)	4.65 (2.22–9.71)	0.000*
	30,000–45,000	20	257	3.36 (1.86–6.04)	2.85 (1.48–5.48)	0.002*
	45,000–60,000	17	51	0.78 (0.40–1.52)	0.75 (0.35–1.59)	0.453
	>60,000	1	6	1.57 (0.18–13.45)	1.22 (0.13–11.38)	0.860
Department	Medicine	20	246	1	1
	Dental medicine	3	11	0.29 (0.08–1.16)	0.32 (0.07–1.41)	0.132
	Pharmacy	45	129	0.23 (0.13–0.41)	0.31 (0.16–0.61)	0.001*
	Radiology	4	44	0.89 (0.29–2.74)	0.59 (0.18–1.93)	0.380
	Laboratory	2	65	2.64 (0.60–11.59)	1.98 (0.43–9.17)	0.380
	Nursing	10	81	0.66 (0.29–1.46)	0.53 (0.22–1.28)	0.156
	Midwifery	2	50	2.03 (0.46–8.97)	2.05 (0.43–9.89)	0.372
Years of study	I	2	14	1	1	1
	II	14	139	1.42 (0.29–6.89)	2.94 (0.50–17.26)	0.231
	III	19	197	1.48 (0.31–7.01)	1.67 (0.29–9.64)	0.568
	IV	18	176	1.39 (0.29–6.64)	1.86 (0.32–10.99)	0.491
	V	30	102	0.48 (0.10–2.26)	1.11 (0.18–6.69)	0.909
	VI	3	43	2.05 (0.31–13.53)	3.36 (0.38–29.59)	0.275

Note: *p-value ≤ 0.05.

Abbreviations: MRH, menstrual-related migraine; ETB, Ethiopian Birr; AOR, adjusted odds ratio; COR, crude odds ratio; CI, confidence interval.