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Headache is considered one of the most common complaints affecting all ages: children, adolescents, and adults. A school-based, cross-sectional study was conducted to assess primary headache among high school students aged 16–18 in Grades 11–12, over a period of 3 weeks (May 2017). A questionnaire was designed, in accordance with the International Headache Society’s criteria. The Pearson’s χ² test was computed to show the differences between the variables. Nearly two thirds of the students reported having headache (19.0% tension-type headache, 8.8% migraine, and 39.0% unknown type). Nearly a quarter sought help for headache, and the most frequently used analgesic was acetaminophen (82.2%) followed by aspirin (5.1%). The current study revealed that the prevalence of headache and migraine was initially high and increased with age. Moreover, headache is one of the major public health problems among high school students. An education program conducted by school nurses and other health-care providers regarding headache and migraine is needed.
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Original Research
Assessment of Headache Among High
School Students in Jordan
Mohammed ALBashtawy, PhD, RN
1
,
Mohammad Al Qadire, PhD, RN
2
, Sami Aloush, PhD, RN
3
,
Loai Tawalbeh, PhD, RN
4
, Manar AlAzzam, PhD, RN
5
,
Mohammad Suliman, PhD, RN
3
, Abdul-Monim Batiha, PhD, RN
6
,
Fadwa Alhalaiqa, PhD, RN
7
, Hind Alshakh, MSN
8
,
and Areej Abd Al-Rahman, MSN
8
Abstract
Headache is considered one of the most common complaints affecting all ages: children, adolescents, and adults. A school-
based, cross-sectional study was conducted to assess primary headache among high school students aged 16–18 in Grades
11–12, over a period of 3 weeks (May 2017). A questionnaire was designed, in accordance with the International Headache
Society’s criteria. The Pearson’s w
2
test was computed to show the differences between the variables. Nearly two thirds of the
students reported having headache (19.0% tension-type headache, 8.8% migraine, and 39.0% unknown type). Nearly a quarter
sought help for headache, and the most frequently used analgesic was acetaminophen (82.2%) followed by aspirin (5.1%). The
current study revealed that the prevalence of headache and migraine was initially high and increased with age. Moreover,
headache is one of the major public health problems among high school students. An education program conducted by school
nurses and other health-care providers regarding headache and migraine is needed.
Keywords
high school, medications, pain, headache, school nursing, migraine
Headache is considered one of the most common complaints
affecting all ages: children, adolescents, and adults (Kernick
& Campbell, 2009; Wo¨ber-Bingo¨l, 2013; Wober-Bingol
et al., 2014). It can be defined as a prevalent and disabling
condition, affecting daily activity levels and the quality of
life, which in the long term increases the economic burden
on society (Albers et al., 2015; Bahrami, Zebardast, Zibaei,
Mohammadzadeh, & Zabandan, 2012). In school-age stu-
dents, it can result in increased absence from school, reduced
daily activities and academic achievement, and impaired
ability to establish and maintain peer relationships (Albers
et al., 2015; Jan, 2007; Murray et al., 2013; Perera, Thushari,
Wanigasinghe, Agampodi, & Silva, 2016; Xavier et al.,
2015; Young-Il, 2017).
Primary headache ranks among the most common disor-
ders worldwide (Pascual, 2011; Xavier et al., 2015). It is a
disorder related to the headache condition itself and not due
to another cause, most often presenting as migraine or
tension-type headache (Friedman & Grosberg, 2009;
Hutchinson, 2011). Primary headache is a major health con-
cern in many Arab and Middle Eastern countries, and studies
have been conducted in Oman (Deleu & Hanssens, 1999;
Deleu, Khan, & Al Shehab, 2002), Saudi Arabia (Al-Tulaihi
& Al-Jumah, 2009; Al Jumah, Awada, & Al Azzam, 2002),
Jordan (Alawneh & Bataineh, 2006; Alzoubi et al., 2009),
Yemen (Abdo, AL-Kamarany, Alzoubi, Al-Maktari, &
Al-Baidani, 2014), and Qatar (Bener, 2006).
1
Community and Mental Health Department, Princess Salma Faculty of
Nursing, Al al-Bayt University, Mafraq, Jordan
2
Adult Healthcare Nursing Department, Faculty of Nursing, Al al-Bayt
University, Mafraq, Jordan
3
Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
4
Adult Health Nursing, Faculty of Nursing, Al al-Bayt University, Mafraq,
Jordan
5
Mental Health Nursing, Faculty of Nursing, Al al-Bayt University, Mafraq,
Jordan
6
Adult Health Nursing, Faculty of Nursing, Philadelphia University, Amman,
Jordan
7
Faculty of Nursing, Philadelphia University, Amman, Jordan
8
Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
Corresponding Author:
Mohammed ALBashtawy, PhD, RN, Community and Mental Health
Department, Princess Salma Faculty of Nursing, Al al-Bayt University,
Mafraq 25113, Jordan.
Email: mohammadbash@aabu.edu.jo
The Journal of School Nursing
1-8
ªThe Author(s) 2017
Reprints and permission:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/1059840517734613
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Nearly 8–10%of the general population in developed
countries report suffering from headache (Pascual, 2011;
Sheftell, 1997). It is one of the most frequent somatic
disorders among children and adolescents, often leading
to self-medication and thence to medication abuse
(ALBashtawy, Batiha, Tawalbeh, Tubaishat, & AlAzzam,
2015; Albers et al., 2015; Sheftell, 1997).
Tension-type headache is the most common primary
headache and can be subdivided into episodic and chronic,
with a serious impact on the quality of life. Migraine, for
example, is the health disorder with the seventh highest
impact on the quality of life and society (Lima et al.,
2014; Vos et al., 2013). According to the International
Headache Society (IHS; 2013) and other international stud-
ies, the pathophysiology of migraine is still not completely
understood, but it is known to be influenced by age, genetic
factors, eating habits, and physical and psychological stress
(Albers et al., 2015; Bakhshi, Naim, Salman, Imran, &
Ashraf, 2016; Xavier et al., 2015). Moreover, according to
the World Health Organization, migraine is the main cause
of headache around the globe and is recognized among the
20 leading causes of disability (Ravishankar, 2004). Many
studies have demonstrated that migraines affect people of all
ages, income levels, race, and geographical regions (Albers
et al., 2015; Stovner et al., 2007).
Headache needs appropriate and full assessment of
family history, physical, psychological, and neurological
examination, with appropriate diagnostic testing. Full
assessment will enable the physician to detect correctly the
cause and type of headache (Jan, 2007; Lima et al., 2014;
Topcu, Hiz, Bayram, Sozmen, & Yis, 2014).
Several studies worldwide indicated that frequent head-
aches can have a considerable impact on the quality of life,
as well as being considered as a disability. Furthermore,
primary headaches with normal neurological status may
cause significant daily pain and increase school absentee-
ism, although they are not dangerous and an improved life-
style can alter the development of the disease and at the end
of the day (Hershey, 2010).
Secondary headaches may be caused by infection, head
injuries, vascular disorders, brain bleed, tumor, and rheu-
matic disease, which may be harmless or may be dangerous,
requiring emergency referral and treatment (Evers & Jensen,
2011; Hershey, 2010). According to the IHS (2013), head-
ache and migraine in children and adolescents can be recog-
nized mainly through a full assessment of a headache
history. This history needs to be directed to the patient and
the parent or guardian. Children and adolescents may need
to have simple questions phrased at a more developmental
level fitting to their ages and understanding (Evers & Jensen,
2011; Hershey, 2010). Parents and family usually base their
answers on their own observations, knowledge, attitudes,
and experience. Health-care providers and school nurses
should focus in-depth on the headache history pattern to
clarify whether or not the headaches are an episodic or a
chronic problem (Hershey, 2010). The pattern of signs and
symptoms may also indicate whether the headache is caused
by another possible cause.
In Jordan, only two studies have covered the problem of
headache and migraine during the last 11 years; neither
assessed the problem in depth. The first (Alawneh &
Bataineh, 2006) discussed the problem of primary head-
ache among schoolchildren aged 6–14 during the period
January to September 2005 and found it prevalent in 24%
of subjects, with migraine accounting for nearly 3%.The
second study (Alzoubi et al., 2009) was conducted among
participants over 18 years of age; it found that 82.3%of
Jordanian adults complained of headache, tension-type
headache (36.1%), and migraine (7.7%). The purpose of
the current study was to assess primary headache among
high school students aged 16–18 years to answer specific
questions related to the characteristics of headache, the
prevalence of tension-type headache and migraine, the type
of medical help and analgesics used, and common symp-
toms associated with migraine.
Method
Research Design and Sampling
A school-based, cross-sectional study was conducted to
address the purpose of the current study among high school
students in Grades 11–12 (16–18 years old, N¼754), over a
period of 3 weeks (May 2017). The participants were chosen
from six high schools located in Mafraq Governorate (three
for girls and three for boys), using a simple random sampling
method. All students in Grades 11–12 (866) in the selected
schools were invited to participate.
Permission was given by the Ethical Approval Commit-
tee of the government university (Al al-Bayt University), the
Mafraq District Education Office, and, verbally, from the
selected schools’ administration.
Measures
The questionnaire was modified from previous studies
(Abdo et al., 2014; Al Jumah et al., 2002; Al-Tulaihi &
Al-Jumah, 2009; Alzoubi et al., 2009; Ismail et al., 2012)
and then revised by five academic staff specializing in neu-
rology and public health. A pilot study with 36 students was
conducted to assess the content and validity of the final draft
of the questionnaire. This helped to assess possible response
rates and the time that would be needed to complete the
questionnaire, 12–20 min.
Data Collection
Letters clearly explaining the survey objectives, the ques-
tionnaire, and two consent forms were given to children to
take home a week in advance of the data collection. The
students and their parents were asked to sign an informed
assent and an informed permission, respectively. The
2The Journal of School Nursing XX(X)
students who returned completed consent and assent forms
were invited to take part on the day of data collection.
The survey was conducted in the students’ schools in
their classes. The students were informed that their partici-
pation was voluntary and that they could withdraw without
penalty. Participants themselves completed the structured
questionnaire regarding their headache characteristics.
Questionnaire
The first part of the questionnaire (20 questions) gathered
sociodemographic data: gender, grade, age, family monthly
income, and mothers’ and fathers’ education. The second
part (12 questions) covered the following topics: type of
headache, time of headache, intensity of the pain, duration
of the pain, frequency per month, effect on daily activity,
absence from school, family history of headache, seeking
medical help for headache, advice on using analgesics,
increase in analgesics used over time, analgesics used for
headache pain, and common symptoms associated with
migraine. The questionnaire was designed according to the
IHS criteria, which is widely used and accepted in epide-
miological surveys worldwide, and was developed as a
result of many years of knowledge and experience of
headache and migraine experts (Headache Classification
Committee of the International Headache Society, 2004).
Data Analysis
Data were coded, entered, and then analyzed using SPSS
Version 20. Means, standard deviations, and frequencies
were calculated. The Pearson’s w
2
test was computed to
show the differences between the variables, and the pvalue
was considered significant at <.05.
Results
Of the 866 students originally invited to participate in the
study, 754 agreed, with an overall response rate of 87.1%.
Four hundred and two participants (53.3%) were boys and
352 (46.7%) girls. Their ages ranged from 16 to 19 years
with a mean of 17.2 (SD ¼1.3). More than a quarter (26.1%)
reported a monthly family income over US$500. Nearly
40%of their mothers and 70%of their fathers had secondary
or further education (see Table 1).
As shown in Table 2, nearly two thirds of the students
reported having headache (19.0%tension-type headache,
8.8%migraine, and 39.0%unknown type). Regarding the
characteristics of headache and family history, two thirds
(65.1%) have headache in the afternoon and a quarter
(24.9%) indicated that the pain was severe. A majority
(61.9%) reported continuous pain with a duration of
4–72 hr and a frequency of 1–4 times per month. This pain
affects their daily activity (60.9%) and absence from school
(58.4%). In addition, nearly 60%indicated that they have a
family history of headache (Table 2). Nearly a quarter
Table 1. Sociodemographic Characteristic of High School
Students.
Characteristics N(%) Mean (SD)
Gender
Boys 402 (53.3)
Girls 352 (46.7)
Total 754 (100)
Age-groups (years)
16–17 451 (59.8) 17.2 (1.3)
>17–18 303 (40.2)
Monthly income ($)
<500 197 (26.1)
500 and more 557 (73.9)
Mother’s education
Less than secondary education 467 (61.9)
Secondary and more education 287 (38.1)
Father’s education
Less than secondary education 212 (28.1)
Secondary and more education 542 (71.9)
Table 2. Characteristics of Headache and Family History Among
High School Students.
Variable N(%)
Type of headache
No headache 247 (32.8)
Tension-type headache 143 (19.0)
Migraine 66 (8.8)
Unknown 298 (39.0)
Time of headache (most of the time)
Morning 177 (34.9)
Afternoon 330 (65.1)
Intensity of the pain (most of the time)
Mild 118 (23.3)
Moderate 263 (51.9)
Severe 126 (24.9)
Duration of the pain (hours)
<4 100 (19.7)
4–72 314 (61.9)
>72 93 (18.3)
Frequency per month
1–4 307 (60.6)
5–9 87 (17.2)
>10 88 (17.4)
Don’t know 25 (4.9)
Affect daily activity
Yes 309 (60.9)
No 198 (39.1)
Increase school absentees
Yes 296 (58.4)
No 211 (41.6)
Family history for headache
No history 317 (42.0)
Father 92 (12.2)
Mother 112 (14.9)
Brothers or sisters 94 (16.6)
More than one family member 103 (13.7)
Don’t know 36 (4.8)
Note. N ¼754.
ALBashtawy et al. 3
sought help for headache and 43.4%were advised to use
analgesics. Twenty-five percent (25.4%) of the students
increased their use of analgesics over time. The most
frequently used analgesic was acetaminophen (82.2%),
followed by aspirin (5.1%; see Table 3).
Table 4 shows the prevalence of tension-type headache
and migraine by age-group and gender. The common
symptoms associated with migraine were increased inten-
sity with physical activity, pulsating pain, followed by
unilateralism (Table 5).
Discussion
Headache is considered one of the common complaints
among children, adolescents, and adults and is the most
common referral to neurology practices worldwide (Ahn &
Rho, 2015; Ferracini, Dach, & Speciali, 2014). The current
study estimated the prevalence and characteristics of head-
ache among high school students aged 16–18, over a period
of 1 year. It is the first study of this kind conducted for 11
years in Jordan and assessed the problem of headache and
migraine in depth to increase the knowledge base. The find-
ings show that two thirds (67.2%) of the participants had
complained of headache during the previous year. This is
lower than the figures previously reported. Alzoubi et al.
(2009) assessed the prevalence of headache among adults
in Jordan at 82.3%and Abdo, AL-Kamarany, Alzoubi,
Al-Maktari, and Al-Baidani (2014) in Yemen at over three
quarters of the participants (76.6%). In contrast, our finding
is much higher than reported by Deleu and Hanssens (1999)
for Oman, where the prevalence of headache was 45%. Our
findings are also higher than the global average of 45%
(Stovner & Hagen, 2006; Stovner et al., 2007), although in
line with other studies conducted in Arab countries such as
Oman (Deleu & Hanssens, 1999; Deleu et al., 2002), Qatar
(Bener, 2006), and Saudi Arabia (Al-Tulaihi & Al-Jumah,
2009).
These differences may be explained by different opera-
tional definitions and measures of headache and migraine,
participants with different sociodemographic characteristics,
the variety of study designs, and high subjectivity of
measurement of pain between individuals (Al-Tulaihi &
Al-Jumah, 2009; Young-Il, 2017).
The findings of the current study should shed light on one
of the major public health issues in Jordan. Tension-type
headache affected nearly one fifth of the students, lower than
the figure reported among adults in Jordan (36.1%; Alzoubi
et al., 2009) and Yemen (27.1%; Abdo et al., 2014) and
lower than the average global prevalence (about 40%; Stov-
ner & Hagen, 2006; Stovner et al., 2007). Additionally, our
finding showed that nearly 9%of the students complained of
migraine, similar to the percentage reported in other Arab
countries (8–12%; Al-Tulaihi & Al-Jumah, 2009; Alzoubi
et al., 2009; Stovner & Hagen, 2006; Stovner et al., 2007)
but lower than that reported in Western Europe (14%;
Stovner & Hagen, 2006).
In the current study, afternoon headaches of moderate
intensity for 4–72 hr duration were considered the major
characteristics. In agreement with Abdo et al. (2014) and
Alzouby et al. (2009), a positive family history of headache
was reported by over half of our participants (53.2%). Sixty
percent reported that this pain affected their daily activities
and increased their absence from school. The effects of
headache on students’ activities and education are difficult
to explain because other confounding factors may affect
them (Abu-Arefeh & Russell, 1994; Young-Il, 2017). In a
study in the United Arab Emirates (Bender, Swadi, Qassimi,
& Udman, 1998), nearly one third of school students
reported missing school because of headache and in Saudi
Arabia nearly half (Al-Tulaihi & Al-Jumah, 2009).
Family is considered as the main source of information on
using analgesics, and 74%of the students did not seek med-
ical attention. Most students in the current study used acet-
aminophen and aspirin as self-medication, in agreement
with the findings of Abdo et al. (2014) and Alzoubi et al.
(2009). This result may be explained by the very low price
and ready availability of over-the-counter medication, with
fewer side effects (Abdo et al., 2014; Alzoubi et al., 2009).
The dangerous habit of self-medication may be increased
among adolescents, leading to drug abuse. Early assessment,
diagnosis, and referral of students suffering from headache
and using self-medication should be conducted to provide
them with the needed medical care.
In agreement with other studies (Abdo et al., 2014;
Alawneh & Bataineh, 2006; Al-Tulaihi & Al-Jumah, 2009;
Table 3. Seeking Medical Help and Use of Analgesics for Headache
Among High School Students.
Variable N(100)
Seeking medical help for headache
Yes 132 (26.0)
No 375 (74.0)
Advice on using analgesics
None 47 (9.3)
School staff 26 (5.1)
Nurse 21 (4.1)
Physician 41 (8.9)
Pharmacists 53 (10.5)
Family 222 (43.8)
Others 97 (19.1)
Increase analgesics used over time
Yes 129 (25.4)
No 356 (70.2)
Don’t know 22 (4.3)
Analgesic used
Acetaminophen 417 (82.2)
Aspirin 26 (5.1)
Ibuprofen 20 (3.9)
Others 44 (8.7)
Note. N ¼754.
4The Journal of School Nursing XX(X)
Alzoubi et al., 2009), the reporting of headache is more
significant among girls than boys. This gender difference
may be explained by two factors: first, different perceptions
of pain between boys and girls, especially in this age-group;
and second, the cultural and social expectations in Jordan
which put more pressure and stress on girls than boys, giving
them less personal freedom, fewer peer relations, and fewer
social choices (Alawneh & Bataineh, 2006; AlAzzam et al.,
2016; ALBashtawy, 2015, 2017; ALBashtawy et al., 2016;
Al-ghzawi, ALBashtawy, Azzeghaiby, & Azzeghaiby,
2014; Al-Tulaihi & Al-Jumah, 2009). In the current study,
increased intensity with physical activity, pulsating pain,
and unilateralism was the major symptoms associated with
migraine. Another study among school students found that
migraine was associated with pulsating pain (74%) and uni-
lateral pain (58%) and that it was increased by physical
activity in some 90%of students (Winner, Rothner, Putnam,
& Asgharnejad, 2003). Our finding was also consistent with
similar studies conducted worldwide (Al-Tulaihi &
Al-Jumah, 2009; Bakhshi et al., 2016).
Implications for School Nursing
Health-care providers and school nurses have a significant
role to play in the early assessment, information collection,
and analysis of all the data related to headache and migraine.
They should participate in further advanced studies and
research to evaluate the current situation of headache and
migraine among students, disseminating healthy interven-
tions that support children’s growth and development and
improve their education and quality of life. Families have a
significant role in educating their children to seek medical
help and to avoid self-medication. Furthermore, parents
should provide schools and school nurses with all relevant
information about their children’s medical conditions and
take this issue seriously because school is the primary setting
in which to identify this problem.
Jordan’s Ministries of Education and Health should col-
laborate to develop a clear strategy and formulate policy
for early assessment, diagnosis, and referral of students
suffering from headache and migraine to provide them
with the necessary medical care. The school nurse is the
key point of contact, who should coordinate, supervise,
and follow the implications of a school policy for head-
ache and migraine and identify all students with this prob-
lem. All school staff, especially teachers, should be aware
of the school policy on headache and migraine, be familiar
with which children have headache, and be aware of what
to do if they have an attack; they should bear in mind that
headache may affect school attendance and performance.
The school nurse should talk about any concerns with the
teachers and parents of students suspected of having head-
ache and migraine, should offer advice on the medical
interventions in a school setting to determine any possible
triggers if attacks frequently occur in school, and should
communicate with the other health-care providers regard-
ing the management of troublesome headache.
The school nurse should also encourage students with
headache and migraine to have a healthy lifestyle, getting
enough sleep, eating regularly, not missing meals, avoid-
ing junk food and fizzy drinks, drinking enough water to
avoid dehydration, and avoiding all headache and
migraine triggers.
Limitations
The current study used a school-based, cross-sectional
design which might be subject to self-reporting bias. Social
desirability bias is also a possibility, where adolescents want
Table 4. Prevalence of Tension-Type Headache and Migraine Among High School Students.
Headache Type
Tension-Type Headache Migraine
N¼143 N¼66
Gender
Boys Girls Total pvalue Girls Boys Total pvalue
N(%) N(%) N(%) N(%) N(%) N(%)
Age (year)
16–17 25 (10.3) 37 (17.7) 62 (13.7) <.05 10 (4.1) 16 (7.7) 26 (5.5) <.05
>17–18 29 (18.1) 52 (36.4) 81 (26.9) 12 (7.5) 28 (19.9) 40 (13.2)
Total 54 (13.4) 89 (26.0) 143 (19.0) 22 (5.5) 44 (12.5) 66 (8.8)
pvalue >.05 >.05
Table 5. Common Symptoms Associated With Migraine Among
High School Students.
Symptoms
a
Frequency (%)
Increase intensity with physical activity 56 (84.8)
Pulsating pain 51 (77.2)
Unilateralism 44 (66.7)
Photophobia 31 (47.0)
Photophobia 29 (43.9)
Nausea and vomiting 19 (28.8)
Note. N ¼66.
a
More than one response.
ALBashtawy et al. 5
to give a good impression in most situations and may over-
estimate or underestimate their responses. A different design
might shed more light on this problem, as the present study
is unable to assess causal relationships between the vari-
ables. Further research with a tested questionnaire regarding
sensitivity and specificity should be done.
Conclusion
The current study revealed that the prevalence of headache
and migraine in Jordan was initially high and increased with
age. Moreover, headache is one of the major public health
problems among high school students aged 16–18, with two
thirds complaining of headache attacks during the previous
year which affected their daily activities and increased their
absence from school; headache may even affect their aca-
demic achievement and make it difficult to establish and
maintain peer relationships. The use of analgesics such as
acetaminophen, aspirin, and ibuprofen may be excessive,
leading to abuse. A health education program on headache
and migraine, conducted by school nurses and other health-
care providers, is needed.
Authors’ Note
Mohammed ALBashtawy contributed to the study design, data
collection and analysis, and manuscript writing and drafted the
final approval of the version to be published. Mohammad Al
Qadire, Sami Aloush, Loai Tawalbeh, and Manar AlAzzam con-
tributed to the study design, data analysis, manuscript writing,
critical revisions for important intellectual content, and supervision
and drafted the final approval of the version to be published.
Mohammad Suliman, Abdul-Monim Batiha, Fadwa Alhalaiqa,
Hind Alshakh, and Areej Abd Al-Rahman contributed to the study
design, data collection, manuscript writing, supervision, and criti-
cal revisions for important intellectual content and drafted final
approval of the version to be published.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
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Author Biographies
Mohammed ALBashtawy, PhD, RN, is an associate professor at
Community and Mental Health Department, Princess Salma
Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan.
Mohammad Al Qadire, PhD, RN, is an associate professor, the
dean assistant for students’ affairs, and the head of Adult Health-
care Nursing Department, Faculty of Nursing, Al al-Bayt Univer-
sity, Mafraq, Jordan.
Sami Aloush, PhD, RN, is an assistant professor at Faculty of
Nursing, Al al-Bayt University, Mafraq, Jordan.
Loai Tawalbeh, PhD, RN, is an associate professor at Adult
Health Nursing, Faculty of Nursing, Al al-Bayt University, Mafraq,
Jordan.
ALBashtawy et al. 7
Manar AlAzzam, PhD, RN, is an assistant professorat Mental Health
Nursing, Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan.
Mohammad Suliman, PhD, RN, is an assistant professor at
Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan.
Abdul-Monim Batiha, PhD, RN, is an associate professor at Adult
Health Nursing, Faculty of Nursing, Philadelphia University,
Amman, Jordan.
Fadwa Alhalaiqa, PhD, RN, is an assistant professor at Faculty of
Nursing, Philadelphia University, Amman, Jordan.
Hind Alshakh, MSN, is a clinical instructor at Princess Salma
Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan.
Areej Abd Al-Rahman, MSN, is a clinical instructor at Princess
Salma Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan.
8The Journal of School Nursing XX(X)
... In this analysis, some questionnaires used to assess headache were based on diagnostic criteria for headaches, such as the International Classification of Headache Disorders (ICHD)/ International Headache Society [14][15][16][17] ; the Health Behavior of Schoolaged Children (HBSC) symptom checklist [18][19][20][21][22][23] ; or other validated or previously used tools. [24][25][26][27][28][29][30] Prevalence estimates have previously indicated that headache is one of the most commonly reported types of pain in children. 31 In 15 studies included in this analysis, estimates of headache prevalence ranged from 17.4% to 67.8% 3,14,19,[21][22][23][24][25][26][27][28][29][30]32,33 (Table 1). ...
... [24][25][26][27][28][29][30] Prevalence estimates have previously indicated that headache is one of the most commonly reported types of pain in children. 31 In 15 studies included in this analysis, estimates of headache prevalence ranged from 17.4% to 67.8% 3,14,19,[21][22][23][24][25][26][27][28][29][30]32,33 (Table 1). In five studies where an age breakdown was available, there were clear increases in head pain prevalence with increasing age, 3,18,23,24,32 although in the report by Keeratisiroj et al. 28 , this age-related increase occurred in girls but not boys from the ages of 9-14 years (48.8%) to 15-19 years (60.3%). ...
... Headache was reported more frequently in girls than in boys in 13 studies where a split according to sex was available. 3,18,20,[22][23][24][25][26][27][28][29][30]33 Indeed, in female-only studies, the prevalence rates were higher than in the mixed-sex studies, ranging from 67.2% to 87.7%. 16,17 There was no difference in headache prevalence between different socioeconomic groups. ...
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Acute pain among children is common, yet it may be underestimated and undertreated if the pain is not recognized. Assessing and managing pediatric pain can be complicated, and as such, measuring the prevalence of acute pain in children can be challenging. We sought to provide a consolidated review of the available data on the prevalence of commonly occurring acute pain in children in the self‐care setting. An extensive literature search was performed to determine the prevalence of acute pain at multiple bodily locations in children aged between 3 months and 18 years. We considered the influence of age, sex, and sociodemographic factors on prevalence estimates. We also sought to identify some of the challenges involved in assessing and managing pediatric pain, thus shedding light on areas where there may be clinical and medical unmet needs. In general, a high prevalence of acute pain in children was detected, particularly headache, menstruation‐related pain, and dental and back pain. Older age, female sex, and lower socioeconomic status were associated with increased pain prevalence. Risk factors were identified for all pain types and included psychological issues, stress, and unhealthy lifestyle habits. Owing to the heterogeneity in study populations, the prevalence estimates varied widely; there was also heterogeneity in the pain assessment tools utilized. The paucity of information regarding pain prevalence appears to be out of proportion with the burden of acute pain in children. This could indicate that clinicians may not be equipped with an optimal pain management strategy to guide their practice, especially regarding the use of developmentally appropriate pain assessment tools, without which prevalence data may not be captured. If acute pain is not accurately identified, it cannot be optimally treated. Further investigation is required to determine how the information from prevalence studies translates to the real‐world setting.
... Furthermore, health-related quality of life is severely diminished among students with headaches [6]. A Jordanian study on high school students revealed that about two-thirds of students between the ages of 16 and 18 years had chronic headaches [7]. Many studies have explored the frequency of the varying types of headaches among both the adult and young population, yet the causes of headaches remain elusive. ...
... As per our study, headaches due to ocular and dental causes were more prevalent among males as compared to the female population. This finding is in accordance with previously published studies [6][7][8]. However, in the age group between 11 and 14 years, there was a small female predominance. ...
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Introduction Headache disorders are becoming increasingly prevalent among the younger population. In this study, we aimed to explore the varying causes of headaches among school-age children in Jordan. Methodology This was a retrospective observational study conducted at the Queen Rania Hospital for Children between June 2019 and June 2020. All the data of the patients were extracted from the patient files with the permission of the administration. All children who were referred to the ophthalmology and dental clinic with headaches as the presenting complaint were included in the study. A detailed history was initially obtained regarding age, gender, medical history, as well as the duration and characteristics of headaches. The patients underwent detailed ocular examination including best-corrected visual acuity (BCVA) using the Snellen chart, anterior and posterior eye segment examination, and intraocular pressure measurement. Refraction under the effect of cyclopentolate was performed for all patients. A detailed dental and oral exam was performed on all children at the dental clinic by the same dentist. Results A total of 712 patients aged between five and 13 years (mean ± SD: 9.3 ± 2.86 years) presented with headaches during the study period. Headaches were more frequent in males [n=441 (61.9%)], but a slight female predominance was found among patients aged 11 years and older. At the ophthalmology clinic, 230 (32.3%) patients with headaches had positive findings; the majority of these patients [n=228 (32%)] had refractive errors with astigmatism as the most common type. Of note, 515 patients (72.3%) had dental caries with a Decayed, Missing, and Filled Permanent Teeth (DMFT) score ranging from 1.5 to 4.3. Conclusion Refractive errors, particularly astigmatism, were found at higher rates among children with headaches. Also, temporomandibular disorders were more prevalent among children with headaches, particularly those aged between 11 and 14 years. Routine ophthalmic and dental assessment is recommended for children presenting with chronic headaches.
... For Philipp et al. [11] in a representative sample of pupils aged 10-18 years in Austria, the prevalence of migraine was 24.2%. Considering other previous studies, the prevalence of migraine among adolescents varied from 8.8 to 49.4% in countries such as Spain, Croatia, Norway, Turkey, Japan, Kuwait, Brazil and Jordania [12][13][14][15][16][17][18][19]. ...
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Objective To investigate the association between migraine and signs and symptoms of eating disorders among teenagers. And as secondary objectives: to investigate the prevalence of eating disorders signs and symptoms and to identify the prevalence of migraine among teenagers. Methods Cross-sectional study was carried out in public schools which included adolescents aged 11–18 years, of both sexes. For eating disorders evaluation two self-reported questionnaires were used: Eating Attitudes Test-26 (EAT-26) and The Bulimic Investigatory Test of Edinburg (BITE). The presence and characterization of headache were verified following the International Classification of Headache Disorders (ICHD-II). Results 607 adolescents (388 females) with mean age of 13.9 years (95% CI: 13.7; 14) were included. The eating disorders symptoms based on EAT-26 (p = 0.041) and the bulimia nervosa symptoms (p = 0.014) evaluation were more prevalent among teenagers with migraine compared with non-migraine. Also, in multivariate analysis, the adjusted odds ratio (OR) to present bulimia nervosa symptoms is 1.85 times higher among females than males. And, the adjusted OR to present bulimia nervosa symptoms among teenagers with migraine is 1.51 times (OR) higher than among non-migraine. Conclusions The presence of migraine symptoms were associated with a higher likelihood to present eating disorders symptoms among teenagers, especially in females, that was associated with a 1.85-fold increase in the risk to present bulimia nervosa symptoms. Level of evidence III, Evidence obtained from cross-sectional study.
... Patients' perceived barriers to handling cancer pain can be influenced by culture (21)(22)(23)(24)(25)(26)(27)(28)(29)(30) . A recent qualitative study aimed to discover the patient's barriers to cancer pain management from the viewpoint of cancer patients and their family. ...
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Background Headache is a common symptom affecting children and adolescents. The medical literature over the last three decades reveals a variable prevalence and triggers in different countries, regions, circumstances and times. This study aims to assess the prevalence, frequency and quality of headaches in the Lebanese adolescent population under the COVID-19 confinement and study its triggers and relationship to screen time, self-reported anxiety, and sleep. Methods A cross sectional design was used to collect two survey results by snowball distribution using social media targeting adolescents aged 15 to 17 years of age. The first survey included 13 questions with a single best answer about screen time, feeling anxious, sleep time, schedule and consistency, and headaches. The second survey included 3 questions about the quality of the headaches, anxiety and its triggers. Results Among 433 responders to the first survey, the prevalence of headaches, especially pressure points and band-like pressure was higher than any previously reported among adolescents in the literature, reaching 93.4%. Screen time was also higher than any previous reports with 95.6% spending 9 hours or more on screen while 64% of adolescents spending at least 12 hours a day on screen. In addition, the majority (82%) don't have consistent sleep habits and 41.8% consider themselves anxious. School was considered the main source of stress by 82.8% of the responders. The frequency of headache correlated significantly with increased screen time, self-reported anxiety and inconsistent sleep habits. Conclusions Headaches among adolescents are associated with increased screen use, sleep disorders, and self-reported anxiety. It is one of the primary somatization symptoms in this group expressing their extreme stress under the current economic, political, and health crisis. The present trends are likely to have major long term implications on adolescents’ health and academic achievements and should alarm educators and health officials to intervene in this situation.
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Regarding the concept of end-of-life care or end-of-life, many of the previous studies were unable to accurately make a clear definition. However, several authors have attempted to provide a succinct definition of this phrase. These two descriptions appear to be general and ambiguous. It seems tough to come up with an accurate or comprehensive description of end-of-life care. The findings of these studies revealed that there are overlapping perspectives and perceptions about the predicted effects of enabling family-witnessed resuscitation (FWR). The bulk of the research analyzed show that the members of the family would desire to attend cardiopulmonary resuscitation (CPR) for their loved ones. This is one of their rights, according to many of them. The majority of patients thought FWR was convenient and would help the resuscitated patient. Nevertheless, a few patients raised concerns about the effect of this presence on the competence of health personnel, including the impact on the resuscitated patient. In research that deal with the examination of health professionals’ views and opinions about FWR, the results were mixed. Several researches have shown that FWR has significant benefits for family members, patients, and health care providers. However, numerous studies have identified concerns about this presentation, such as the psychological impact on family members, the additional stress that this presence may cause for health professionals, and the potential for legal action in consequence of this presence.
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Pediatric chronic orofacial pain (OFP) is an umbrella term which refers to pain associated with the hard and soft tissues of the head, face, and neck lasting >3 months in patients younger than 18 years of age. Common chronic pediatric OFP diagnoses include temporomandibular disorder, headaches, and neuropathic pain. Chronic OFP can adversely affect youth's daily functioning and development in many areas of well-being, and may be associated with emotional stress, depression, functional avoidance, and poor sleep, among other negative outcomes. In this mini-review, we will discuss common psychological comorbidities and familial factors that often accompany chronic pediatric OFP conditions. We will also discuss traditional management approaches for pediatric orofacial pain including education, occlusal appliances, and psychological treatments such as relaxation, mindfulness-based interventions, and cognitive-behavioral treatments. Finally, we highlight avenues for future research, as a better understanding of chronic OFP comorbidities in childhood has the potential to prevent long-term pain-related disability in adulthood.
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Studying the family as context is one of the approaches that focus on “persons/family members” or “individual/family subgroup” and their relationships as foreground, with the family as background. Individual family subgroup research focuses on persons as individuals and as family members and their relationship to the family from the perspective of the subject individually and in interaction .
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Objective: To determine the prevalence of primary headache among school children in the age group of 11-16 years in the Polonnaruwa educational zone. Method: This was a school based cross sectional study. Study population was school children aged 11-16 years in Polonnaruwa educational zone. A self-administered questionnaire was used for screening. In those identified, a clinical examination and second questionnaire were used to collect further data. The diagnosis of migraine and tension type headache was based on the second edition of the International Headache Society's International Classification of Headache Disorders (ICHD II). Results:A total of 683 students aged 11-16 years were invited to participate in this study out of which 606 responded (88.5%).The median age of the study sample was 13 years (Interquartile range 12-15). There was a slight female predominance (50.7%). Except for 32 (5.3%) students, all others experienced headache at least once in their lifetime and 541 (89.3%) had headache during past 12 months. Recurrent headache for at least for 3 months was reported by 39.8%, and 86.4% (208) of them had presented at least once to the General Hospital Polonnaruwa for evaluation previously. After further evaluation, 194 students were found to have primary headaches and secondary causes were found in the balance 14. The prevalence of migraine in this study sample was 7.8%, with 53.2% having migraine with aura. The prevalence of tension type headache was 2.81%. Majority (67%) of the 194 with primary headache had unclassified headache. Migraine was more common among girls (9.1%) compared to boys (6.4%). However, this observed high prevalence was not statistically significant (p=0.204). Tension and unclassified headaches had no variation according to the age and sex. Conclusions: Primary headaches occurred in 94% of children aged 11-16 years in the Polonnaruwa educational zone. The prevalence of migraine was 7.8%.
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BACKGROUND: The aim of this study was to determine the frequency of headache disorders in undergraduate medical students of Karachi, Pakistan and determination of various associating factors. METHODS: This was a descriptive cross-sectional study including 402 participants. All were medical students from first year to final year enrolled at two medical colleges of Karachi, Pakistan. The ethical approval of study was obtained from Dow University of Health Sciences. The students were inquired about the occurrence of headaches during the past one year and various triggering and risk factors. RESULTS: Headaches were experienced by 87.8% students (N=353; females= 249). Of these, 17.8% were found to have migraine, 75.3% had tension-type headache (TTH), 4.0% had both migraine and TTH and 2.3% suffered from cluster headaches. A quarter of students suffering from headache were found to have a positive family history, while stress, fatigue, sleep disturbance and nasal congestion were the most commonly reported trigger factors. More than half (60%) students stated that they did not take any medications for headaches. CONCLUSION: This study found a very high frequency of headache among medical students of Karachi, Pakistan. A number of trigger factors were identified which if curtailed may reduce the occurrence of headache. Keywords: Headache; Medical Students; Migraine; Tension-type Headache; Trigger Factors
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Nonfatal injuries are considered as one of the major public health hazards affecting schoolchildren, and the majority of these injuries occur at school or in the home. A cross-sectional study was conducted over a period of 3 months, March–May 2015. The participants were 4,355 Jordanian schoolchildren in Grades 7–12. The Pearson χ2 test was computed, and the odds ratio was used to determine the magnitude of various risk factors for nonfatal injuries among schoolchildren. The overall incidence of nonfatal injury was 33.9%. The group most likely to sustain nonfatal injuries was boys, aged 12–15, in Grade 7, whose parents had a low level of education or a high family income. Injury prevention in schools and at homes is a cornerstone for protection or reducing the incidence of injuries. School nurses have a duty to follow up and examine the accident reports and evaluate whether safety policies are applied and are effective in different school settings. Furthermore, health and education authorities should develop a national program for preventing injuries.
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Prevalence of headache in adolescents and association with use of computer and videogames abstract The aim of this study was to determine the prevalence of headache in adolescents and its association with excessive use of electronic devices and games. The sample comprised 954 adolescents of both sexes (14 to 19 years) who answered a questionnaire about use of computers and electronic games, presence of headache and physical activity. The binary and multinomial logistic regression , with significance level of 5% was used for inferential analysis. The prevalence of headache was 80.6%. The excessive use of electronics devices proved to be a risk factor (OR = 1.21) for headache. Subjects aged between 14 and 16 years were less likely to report headache (OR = 0.64). Regarding classification, 17.9% of adolescents had tension-type headache, 19.3% had migraine and 43.4% other types of headache. The adolescents aged form 14 to 16 years had lower chance (OR ≤ 0.68) to report the tension-type headache and other types of headache. The excessive use of digital equipment, electronic games and attending the third year of high school proved to be risk factors for migraine-type development (OR ≥ 1.84). There was a high prevalence of headache in adolescents and high-time use of electronic devices. We observed an association between excessive use of electronic devices and the presence of headache, and this habit is considered a risk factor, especially for the development of migraine-type.
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Abstract Background A healthy breakfast provides school-age children with the essential nutrients needed for their activities and is correlated with improving a person's general nutritional status. Methods A cross-sectional study was conducted over a period of two months in 2015, involving 1798 Jordanian schoolchildren from grade 1 to grade 6. The study data sheet covered the breakfast habits of those children. Descriptive measures and Pearson's chi-square test were computed. Multivariate regression was calculated to assess the predictors' factors for breakfast consumption. The p value was considered significant at p < 0.05. Results Findings show a prevalence for breakfast consumption of 80.4%. Furthermore, 52.1% of the breakfast eaters indicated that it was a family habit; half of them ate breakfast in order to be active and energetic and to alleviate hunger during the morning. Live with both parents, age groups of 6–9 years and boys were the predictors of breakfast consumption among schoolchildren. Conclusion Breakfast skipping among schoolchildren was initially high and increased with age. The findings suggest a community health education programme, conducted by school nurses, nutritionists and other health professionals, is needed.
Article
Background: Headache is a common symptom with a high prevalence in most epidemiological studies. It is one of the 10 most common reasons for outpatient physician visits. Headaches are common in children and the prevalence increases with increasing age. The aim of the study: was to find out the prevalence of headache among school age children and study different attributes associated with headaches in Ain Helwan district. Method: Descriptive research design was carried out at primary, preparatory and secondary public schools in Ain Helwan district. Subjects: included 378 school age children 10-17 years, from both gender. Sample: A simple random sample was recruited, utilizing the non-probability sampling technique. Tool: The researchers utilized selfadministered interview sheet to collect data in relation to personal information of the studied sample, their eating habits, and life style pattern. Data were collected in the period from beginning of March 2011 till the end of April 2011. Results: revealed that, out of 378, students 221 were complaining from headache (58.5%). No statistically significant differences were detected between middle childhood and late childhood students regarding dizziness during car riding, sensitivity to certain smile, extreme noise, in addition to intensity of headache that increases with climbing stairs, sport, cough, change body posture, activity, teeth or gums' pain, ear problems, nervousness, vision problems and taking vitamins or drugs. Less than three quarters of sample had inadequate or irregular sleep (72.4%) and there were highly statistically significant differences between middle childhood and late childhood students regarding inadequate or irregular sleep and eating chocolate or cheese, skipping meals, drinking caffeine, staying long time in front of TV or computer, ingestion of cold drink or ice cream, smoking, and complying of any unhealthy condition. More than three quarters of the studied sample showed clinical manifestations of headache in stabbing pain followed by pressing headache (83.7% & 77.8 % respectively). Results revealed adverse effects of headache through scholastic achievement, school attendance and daily activity with no significant differences. Conclusion: Headache represents a common disabling health problem among school age children in Ain Helwan district with a prevalence rate of 58.4%. In general, the prevalence of headache increases with age and it is higher in males than females. Stress following staying long time in front of TV or computer was the most common precipitating factor for headache in the study. Recommendation: Health education of the parents and children about the precipitating factors which triggers for headache, and increasing awareness about healthy life style, and early diagnosis and treatment of headache are recommended to avoid its drawbacks on child health and school performance.