Prevalence and risk factors associated with headache amongst medical staff in South China

DOI: https://doi.org/10.1186/s10194- 020- 1075- z

Abstract-Summary A previous study by our team reported the prevalence of primary headache disor- ders and factors associated with headache among nurses in three hospitals in North China.

Among 645 medical staff, 548 (85%) responded (doctors = 240, nurses = 308). Among the medical staff, the 1-year prevalence of primary headache disorders was 50%, with 25.9% experiencing migraine and 24.1% experiencing tension-type headache (TTH).

The prevalence of migraine in female doctors was higher than that in female

nurses, although this difference was not significant (32.4% vs. 29.8%, p = 0.628).

Multivariate analysis showed that being female and working in other specialties (Emergency Department & Radiology Department) remained independent risk fac- tors for migraine in doctors (OR 2.314 and 3.223).

Working more than 6 night-shifts per month was associated with an increased prevalence of migraine and TTH in doctors; the same was true in nurses for migraine, but not for TTH.

The prevalence of primary headache disorders in both nurses and doctors is

higher than that in the general population in South China.

Further, female doctors are more susceptible than female nurses to migraine. The risk factors relevant to headache that were found in this study should provide an important reference for promoting occupational health in medical staff, espe- cially female doctors in China.

Extended: The prevalence of both migraine and TTH peaked during middle age (30–39 years) in the nurse and doctor groups but were higher in the former group than in the latter (migraine: 31.4% vs. 25.2%, p = 0.168 < 0.05; TTH: 29.1% vs. 24.3%, p = 0.213 < 0.05).

The prevalence of TTH was significantly higher for some nursing roles (nurse: 15.6%, nurse practitioner: 34.0%, p < 0.001), but this was not observed for doctors (resident: 22.5%, attending physician: 26.6%, deputy chief physician or above: 21.3%, p = 1.000 > 0.05).

The prevalence of migraine and total headache did not significantly differ with

title for either doctors or nurses.

Background A population-based study in China showed that the 1-year prevalence of primary headache disorders was 23.8% [4], which appears to be much lower than that in other countries and regions.

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1 Public Health

European regional studies showed that 53%–75%of people experienced head- ache disorders, while the 1-year headache prevalence was 45% in Ethiopia and 62% in Zambia [46].

In North China, we found that the prevalence of primary headache disorders in nurses was significantly higher than that in the general population (45.3% vs. 23.8%) [54].

We sought to provide recent statistics on the prevalence of primary headache

disorders in medical staff in South China.

Our aims were to update prior prevalence estimates and to identify other factors relevant to headache disorders among medical staff in China, which should be a supplementary extension of “Lifting The Burden” in China.

Methods In each hospital, we randomly selected eight clinical departments, from which all doctors and nurses were invited to participate the headache survey.

All those reporting headache were interviewed after their questionnaires were

reviewed by neurologists.

Neurologists, who had been systematically trained with The International Classification of Headache Disorders, third edition (ICHD-3) tool and the survey, explained the notes for the questionnaire and answered the participant’s questions.

Each participant completed the structured questionnaire to gather demographic data, occupation-related factors and headache characteristics over the previous year. The demographic and headache profile sections of the questionnaire were the same items as used in a Chinese national epidemiology study, and were validated for headache assessment and diagnosis in the general population [4, 54, 55].

All those reporting headache were invited to interviews after their questionnaires

were reviewed.

In face-to-face interviews, trained neurologists would confirm the headache

diagnosis based on the ICHD-3.

Results Specialty did not correlate with any type of headaches in doctors (migraine: internal medicine: 20.3%, surgical department: 19.2%, other specialties: 34.5%, p = 0.786 > 0.05; TTH: internal medicine: 22.5%, surgical department:27.4%, other specialties: 17.2%, p  =  1.000  >  0.05) or with TTH in nurses (internal medicine: 26.2%, surgical department: 22.8%, other specialties: 26.1%, p = 1.000 > 0.05).

Seniority and work arrangement had no effect on the prevalence of headache,

including migraine and TTH, in doctors or nurses.

Among the nurses, marital status and specialty were not identified as risk factors for TTH in the multivariate logistic regression analysis, and age, nationality, educa- tion, BMI, seniority, and work arrangement were not identified as risk factors for either type of headache.

Discussion We found that the 1-year prevalence of primary headache disorders among medical staff in Sanya, South China, was 50% (migraine: 25.9%; TTH: 24.1%), which was

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Epidemiology

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significantly higher than the 23.8% (migraine: 9.3%; TTH: 10.8%) obtained in a population-based study in mainland China [4].

Another study [54] recruited 1102 nurses among which only 10 respondents had two types of primary headache and only 2 were diagnosed with both CDH and MOH, suggesting nursing staff had lower prevalence of MOH and CDH than the general population.

This study is the first to investigate the prevalence of primary headache disorders among doctors in mainland China (45% had primary headache disorder: 21.7% had migraine, and 23.3% had TTH).

A senior job title was significantly associated with a greater prevalence of head- ache (both TTH and migraine) in nurses, indicating that occupational factors affected the prevalence of headache.

Conclusion Our study shows that the prevalence of primary headache disorders (including migraine and TTH) in both nurses and doctors is higher than that of the general population in South China.

Acknowledgement A machine generated summary based on the work of Xie, Wei; Li, Ruibing; He, Mianwang; Cui, Fang; Sun, Tingting; Xiong, Jianmei; Zhao, Dengfa; Na, Weinan; Liu, Ruozhuo; Yu, Shengyuan. 2020 in The Journal of Headache and Pain.

Prevalence and comorbidity of migraine headache: results from the Singapore Mental Health Study 2016