ورقة علمية / Research Paper

Background Migraine is a common and often debilitating primary headache disorder characterized by recurrent attacks of moderate to severe pulsating pain, frequently accompanied by nausea, photophobia, and phonophobia. According to the Global Burden of Disease Study, migraine ranked as the second leading cause of years lived with disability (YLDs) worldwide in 2019, particularly affecting young and middle-aged adults—the majority of whom are in their productive and academic years (1). Among university populations, medical students are disproportionately affected due to their high academic demands, stress levels, irregular sleep patterns, and unhealthy coping behaviors (2,3). The prevalence of migraine among medical students has been consistently shown to be higher than in the general population. A systematic review and meta-analysis by Woldeamanuel and Cowan (2022) reported a global pooled prevalence of migraine among medical students at 16.1%, with regional variations noted across continents (4). In Sudan, a study conducted at the University of Khartoum found that the prevalence of migraine among medical students was 18.6%, with higher rates observed among females and final-year students (5). Similarly, another study in Egypt reported a prevalence of 27.9% among medical students, highlighting the burden of migraine in North African contexts (6). Beyond physical symptoms, migraine significantly affects students’ academic performance, concentration, attendance, and overall quality of life. Evidence suggests that migraineurs are more likely to experience poor academic outcomes, including missed lectures and reduced exam performance (7). A study conducted in Saudi Arabia showed that more than 60% of migraine-affected students reported a moderate to severe impact on academic performance, with many experiencing absenteeism and decreased productivity during migraine attacks (8). Additionally, chronic migraine has been associated with heightened anxiety, depression, and poor sleep quality, further exacerbating academic difficulties (9). Despite this growing body of international literature, there is limited data from Sudan addressing both the prevalence and the academic impact of migraine among medical students. As academic stressors and healthcare infrastructure in Sudan differ from those in high-income countries, it is essential to assess the local burden and its implications for academic success. The current study aims to fill this gap by estimating the prevalence of migraine among medical students and evaluating its impact on their academic performance. Understanding this relationship will inform university health services and academic policies to better support affected students. Problem Statement Migraine is a major yet under-recognized health problem among medical students. While international studies have reported high prevalence rates and significant academic impairment due to migraine, there remains a lack of localized data from Sudanese universities The few studies available in Sudan focus mainly on prevalence, without adequately exploring how migraine affects academic performance and psychological well-being. Consequently, students who suffer from migraines may continue to be overlooked in terms of diagnosis, support, and academic accommodations. This gap in research and institutional awareness puts affected students at risk of poor academic outcomes, stress-related complications, and long-term disability. Justification This study is important for several reasons: 1. High-Risk Population: Medical students are especially vulnerable to migraine due to their high stress levels, sleep disturbances, and prolonged mental exertion—all recognized triggers of migraine. 2. Academic Consequences: Migraine is not only a personal health issue but also a determinant of academic success. Students with migraine are more likely to have lower grades, higher absenteeism, and reduced cognitive function during attacks. 3. Lack of Local Data: While Sudanese students face unique socioeconomic and academic stressors, no study has yet examined the prevalence and academic impact of migraine at the University of Bahri. This study will fill that gap and provide evidence-based recommendations. General Objective To determine the prevalence of migraine and assess its impact on academic performance among medical students in Northern Sudan Specific Objectives 1. To estimate the prevalence of migraine among medical students using the International Classification of Headache Disorders, 3rd edition (ICHD-3) diagnostic criteria. 2. To identify the demographic and lifestyle factors associated with migraine occurrence among medical students. 3. To assess the frequency, duration, and severity of migraine attacks among affected students. 4. To evaluate the impact of migraine on academic performance indicators such as class attendance, concentration, exam performance, and study productivity. 5. To explore the coping strategies, healthcare-seeking behaviors, and use of medication among students with migraine. 6. To identify the association between migraine and psychological factors such as stress, sleep quality, and anxiety among medical students. Methodology Study Design This will be a descriptive cross-sectional study conducted among medical students in Northern Sudan to assess the prevalence and academic impact of migraine. Inclusion Criteria - Registered medical students from 1st to 6th year. - Students who consent to participate in the study. Exclusion Criteria - Students with incomplete or missing data in the questionnaire. - Students with a known diagnosis of other neurological disorders (e.g., epilepsy, brain tumors) that may mimic migraine symptoms. Sample Size Determination Sample size will be calculated using the formula for prevalence studies: n=z².p(1-p)/d² Where: Z= 1.96 (for 95% confidence interval) P= .186 (based on a previous study in Sudan reporting 18.6% prevalence of migraine among medical students) (6) d= 0.05 (margin of error) n = 233 Adding 20% for non-response and incomplete questionnaires: 233 + (0.20 × 233) ≈ 280 Thus, the final sample size will be approximately 280 students. Sampling Technique A stratified random sampling method will be used. The student population will be stratified by academic year (1st to 6th), and proportional random samples will be taken from each stratum to ensure representativeness. Data Collection Tool A structured self-administered questionnaire will be used. It will consist of four main sections: 1. Demographic and Lifestyle Information: age, gender, academic year, sleep habits, caffeine intake, family history of migraine, etc. 2. Migraine Screening: based on the ICHD-3 diagnostic criteria and the validated ID Migraine™ screener. 3. Migraine Characteristics: frequency, duration, severity (measured using the Visual Analog Scale), triggers, and associated symptoms. 4. Academic Impact: measured using a modified version of the Migraine Disability Assessment (MIDAS) questionnaire and items assessing concentration, attendance, academic performance, and psychological stress. The questionnaire will be adapted from validated instruments used in previous migraine studies (1,7,8) and reviewed by experts for content validity. A pilot test will be conducted with 20 students not included in the final sample to ensure clarity and reliability. Data Collection Procedure Data will be collected electronically (via Google Forms). Participants will be approached during lecture hours with permission from faculty. Informed consent will be obtained before participation.Anonymity and confidentiality will be strictly maintained. Data Management and Analysis Data will be entered into Microsoft Excel and analyzed using SPSS version 25

Informed consent will be obtained from all participants. Participation will be voluntary, and students can withdraw at any point without penalty. Data confidentiality and anonymity will be maintained throughout the study.

By identifying the extent to which migraine affects attendance, concentration, and examination performance, the findings can guide academic administrators in developing supportive policies such as flexible attendance considerations, academic counseling, and stress-management programs