Ousting the Pain: Migraine in University Students

Migraines are severe headaches that are isolated to one side of the head and are often accompanied with nausea, sensory disturbances, and fatigue. Migraine occurrences have increased worldwide. A recent systematic review and meta-analysis published in the European Journal of Pain investigated global migraine prevalence and factors that increase migraine occurrences in students.¹

Migraines cause severe throbbing or pulsing pain and can be episodic or chronic. Migraines are characterized into 2 categories: migraines with aura and migraines without aura.

Many pharmacologic and nonpharmacologic therapies are available to treat migraines. Pharmacologic migraine treatments include non-steroidal anti-inflammatories (NSAIDs), calcitonin gene-related peptide (CGRP), monoclonal antibodies, ditans, gepants, triptans, neuromodulation, and onabotulinumtoxin A. Nonpharmacologic migraine treatments include nutraceuticals, psychosocial therapies, and holistic approaches.

Migraine prevalence has increased globally, affecting 14% of the general population and 16% of students, whereas pooled prevalence increased to 19%. Women were found to have a higher likelihood of experiencing migraines compared to men and a higher chance of obtaining medical treatment for migraines.

Migraine attacks commenced during puberty, with increased prevalence in females during reproductive age due to hormones. Migraines were found to be more common in high-income countries than low-income countries.

This meta-analysis included studies with various timeframes. The authors found that studies looking at 3- to 6-month timeframes may underestimate total migraine prevalence, whereas other studies using 3- to 12-month timeframes reported a higher migraine frequency. Only studies using the international classification of headache disorder’s case definition of migraines were included.

Medications were commonly used to treat or abort migraine attacks; however, studies found that migraine medications were insufficiently used. Patients who were diagnosed and treated by a specialist used medications more completely compared to patients who self-medicated.

The NICE (National Institute for Health and Care Excellence) migraine guidelines state that ergots, opioids, and oral contraceptives should not be first-line options offered to patients. The guidelines also emphasize the need to discuss the risks for migraine overuse headache (MOH).

The American Migraine Foundation defines MOH as, “a chronic daily headache and a secondary disorder in which acute medications used excessively causes headache in a headache-prone patient.”² Despite being highlighted in the guidelines, very few studies reported MOH prevalence and contraceptive use, but some studies found that students used ergots and opioids for migraine relief and treatment.

CGRPs are a newer class of medications and are more expensive than other agents, which can be a barrier for some patients. Sleep and rest were found to be the most documented non-pharmacological remedies.

Pain is best managed by a comprehensive approach that encompasses both pharmacologic and non-pharmacologic therapies. Students may be hesitant to discuss migraines, which can lead to absences, difficulties in personal life, financial burdens, and poor mental health. Therefore, migraine education may be beneficial for students and educators.

Overall, this meta-analysis included very diverse studies leading to an inability to quantitatively analyze factors associated with migraines. Sixty-six percent of studies provided prevalence through self-reports and 75% of studies documented timeframes for determining migraine occurrences.

As a result of the study heterogeneity, further research is needed to determine migraine risk factors, recognition, and treatments.

About the Author

Anne Lin, PharmD, BCPS,is an emergency medicine clinical pharmacist at St. Vincent’s Medical Center in Bridgeport, CT.

References

1. Flynn O, Fullen BM, Blake C. Migraine in university students: A systematic review and meta-analysis. Eur J Pain. 2023;27(1):14-43. doi:10.1002/ejp.2047
2. Headache from Medication Overuse | AMF. American Migraine Foundation. Accessed January 24, 2023. https://americanmigrainefoundation.org/resource-library/medication-overuse/