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| ARTICLE |
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| Year : 2018 | Volume
: 19
| Issue : 1 | Page : 91-95 |
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Headache among nursing staff
Sarah Maranatha Priya1, Mercy Jesudoss2, Deborah Snegalatha3, Rebecca Sumathy Bai4, Vivek Mathew5
1 IV Year Student, College of Nursing, CMC, Vellore, India
2 Assoc Professor, College of Nursing, CMC, Vellore, India
3 Junior Lecturer, College of Nursing, CMC, Vellore, India
4 Professor, College of Nursing, CMC, Vellore, India
5 Professor, CMC, Vellore, India
| Date of Web Publication | 11-Jun-2020 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None
Headache disorders are a worldwide problem. It is the most common form of pain and a major reason for days missed at work or school as well as visits to the doctor. Headache among professionals can be disabling affecting their productivity at workplace. There is scarce data available to know the headache occurrence among health care workers particularly nurses. A cross-sectional study was done to assess the headache occurrence, experiences and management among nursing personnel working in neurology and polytrauma wards of a tertiary care centre in South India. Sixty nurses who fulfilled the inclusion criteria were selected by convenience sampling method. A self-reported, investigator prepared questionnaire was used for data collection. Majority of the nurses (85%) had headache 1- 4 times and 15% had more than 5 times in the preceding month. Among the subjects 75 % were able to tolerate the headache but 25% stated that headache was intolerable. It was identified that fatigue (15%) and inadequate sleep (48%) were the major triggers of headache. Among the subjects 40% used acetaminophen, 17% used pain balm and 26 % used combination of acetaminophen and pain balm for pain relief. Nursing is a profession that demands mental and physical etiquette for handling patient care activities. Therefore it is important to identify headache and its triggering factors to further prevent this distressing symptom.
Keywords: headache, nursing, pain relief
How to cite this article:
Priya SM, Jesudoss M, Snegalatha D, Bai RS, Mathew V. Headache among nursing staff. Indian J Cont Nsg Edn 2018;19:91-5 |
| Introduction | |  |
Headache disorders are a worldwide problem; despite regional variations, it affects people of all ages, races, socioeconomic status and geographical areas. It is the most common form of pain and a major reason for days missed at work or school as well as visits to the doctor. An individual experiences headache between once or twice a year and more than 15 days a month (World Health Organization, [WHO] 2016) ). Headache varies in frequency and severity. Pain ranges from mild to severe and often is accompanied by symptoms such as nausea or increased sensitivity to noise or light depending on the type of headache. Headache among professionals can be disabling affecting their productivity at workplace. There is scarce data available on headache occurrence among health care workers particularly in nurses.
The International Headache Society (2018) classifies more than 150 types of primary and secondary headache disorders. Primary headache occurs independently, irrespective of co-morbidities. Migraine, Cluster, and Tension Type Headache (TTH) are the common types of primary headache. Secondary headaches are symptoms associated with a health disorder which causes pain-sensitive nerve endings to be either pressed, pulled or pushed out of place most commonly resulting from fever, infection, medication overuse, stress or emotional conflict, high blood pressure, psychiatric disorders, head injury or trauma, stroke, tumors, and nerve disorders.
According to the WHO (2016), headache is a symptom of a range of neurobiological disorders and adults aged 20 to 50 years are most likely to suffer. Globally, an estimated prevalence of headache experienced by adults atleast once during the preceding year is around 50%. Occurrence of headache for 15 or more days every month affects 1.7 - 4% of this population. Headache occurs in both sexes and in all age groups but the highest prevalence is among women between 20 and 50 years (Stovner & Andree, 2010).
It is predicted by the researchers that headache disorders would rank among the first 5 most disabling conditions for both the genders and into the five most disabling conditions for women in particular (Stovner et al., 2007). A cross sectional population based study done in Kashmir valley, India in 2016 reported an overall prevalence of headache as 66.2% with female preponderance in all age groups. Headache occurred in 79.9% adults between 19 and 45 years. A decline in the prevalence was observed in both genders after 45 years of age (Masoodi, Shah, & Iqbal, 2016). Similar findings were reported in Southern India from where the present study was done. The analysis revealed a prevalence of headache in 63.9% with a female preponderance of 4:3. People from rural locality had a higher prevalence as compared to urbanites (Kulkarni, Rao, Gururaj, Stovner, & Steiner, 2015).
A Croatian population based survey by Zivadinov et al. (2003) reported stress, sleep disturbances, eating habits, menstrual cycle, use of oral contraceptives, certain food items, changes in weather conditions and temperature, frequent travelling and physical activity as the triggers for headache. Among nurses, workload and negative perception of health status contributed to the occurrence of headache (Lin, Huang, & Wu, 2007). Sometimes, headaches are initiated by trigger factors that increase the probability of an episode. The triggers are highly individualized. They could be both exogenous and endogenous in an environment that temporarily increases the intensity and probability of a headache. Triggers are heralded by premonitory symptoms warning an impending attack.
Considering the increase in prevalence of headache and very few reported studies among health care workers, it is imperative to gain more knowledge on headache among professionals. Assessing the occurrence, experience, characteristics, triggers, and management strategies of headache among nursing personnel will help the individual to develop strategies to prevent their occurrences as well as for the supervisors to offer possible support in the clinical area. Hence, the student researcher and faculty were interested in assessing the above-mentioned aspects of headache among the nursing personnel who work in the neurology and polytrauma wards.
The study was done with the following objectives
- To assess the characteristics, triggering factors and experiences of headache among nurses working in neurology and poly trauma wards
- To identify the self-management measures carried out by the nurses to handle headache
| Methods | | |
A cross-sectional study design was used. Sixty nursing personnel working in the neurology and polytrauma wards of a tertiary care center consented to participate in the study. A verbal consent was obtained from the subjects. The demographic profile of the subjects and a self-administered questionnaire comprising of 17 questions to assess the prevalence of headache among nursing personnel, its triggering factors, experiences and management was developed and utilized to collect data. Nursing and medical experts validated the content of the questionnaire. A convenience sampling technique was employed to select the subjects. Nurses with a minimum of 6 months experience in the particular unit were selected for the study. Nurses who had an episode of headache in the preceding month and present during the time of data collection were included in the study. A time schedule accommodating the various shifts of the study subjects was made at the beginning of each week and the data was collected from 60 subjects over a period of two weeks. Confidentiality of the information was ensured by maintaining anonymity of the participants. The data was analyzed using descriptive statistics.
| Results and Discussion | | |
It is evident from [Table 1] that more than half (59%) of the subjects were less than 30 years of age. Among the 60 subjects, 4 of them were male and 97% of them had undergraduate training, either bachelors or general nursing. Around 63% of the subjects were married. Majority (28%) had 6 months to three years of experience and 24% had 3-6 years of experience.
The subjects were asked about the characteristics of headache experienced. The analysis on frequency of headache (see [Table 2]) revealed that majority (85%) of the nurses had headache 1 - 4 times and 15% had more than 5 times in the preceding month. Each episode of headache lasted for less than 2 hours in 67% of the subjects. Nearly half of the subjects (43%) had headache in the temporal region. The description of pain experienced during an episode varied from throbbing (38%), tight band like (20%), sharp or pricking (27%) to pounding headache (15%). The experience of headache in the recent past as reported by the subjects revealed that 15% of them felt that the headache had worsened, 37% experienced the same and around 48% felt better. Although 75% of the subjects were able to tolerate the headache, there were 25% (n=15) of them still felt headache as intolerable.
Regarding the factors that triggered (factors that initiated a headache) the episode, it was found that fatigue (15%) and inadequate sleep (48%) were major triggers for headache among nurses (see [Table 3]). The findings are congruent with the study done by Wang et al. (2015) where the frequency of headache among the subjects with poor sleep and rotating shifts were independent risk factors for sleep disorders. Night shift work may lead to sleep disturbance and fatigue which are common triggers for headache. Considering stress as a major aggravating factor (factors that increased the pain) (50%) in this study, it is assumed that the headache could be Tension Type Headache (TTH). Half of the nurses (50%) found mental stress to aggravate their headache, whereas only 18% found workload as an aggravating factor. This data contradicts the findings of Lin et al. (2007) who reported that work-load was associated with occurrence of headache among Chinese nurses (p< .001). Neck pain, fatigue, mood changes, nausea and decreased appetite were some of the associated symptoms the subjects experienced during an episode of headache (see [Table 3]).
The study also looked into the various management strategies handled by subjects for their headache relief (see [Table 4]). The data suggests that majority of the subjects (40%) used acetaminophen, 17 % used pain balm and 26% used a combination of acetaminophen and pain balm during an episode of headache. Lin et al.(2007) and Bendtsen et al. (2010) reported similar findings where headache was managed with Tab. Acetaminophen and simple analgesics or a combination of NSAIDs along with coffee intake respectively. Around 27% of the subjects consumed 4 - 6 times coffee during an episode of headache, which is consistent with the findings of Bendtsen et al. (2010). Subjects, owing to their familiarity with medications tend to self-medicate during an episode of headache. The findings of the present study and the related review are highly suggestive of the fact that the use of acetaminophen and NSAIDs are common among Asian nurses. Although most of the complementary therapies in medicine have its roots of origin from the Asian countries, none of the studies has reported the use of these therapies among nurses in the South-East Asian countries. Forty seven percent of the subjects in this study found sleep and rest to help them relieve their headache and similar findings were reported by Lin et al. (2007).
Subjects were asked to rate their experiences during headache in relation to difficulty in performance of work, agitation, and alteration in sleep wake cycle (see [Figure 1]). More than half the (60%) subjects rarely had difficulty in performance of their work and 60% were rarely agitated due to the headache. Of the 60 subjects, 58 of them work seven days of night shifts a month and all of them experienced atleast one episode of headache in the preceding month. Twenty-seven percent of them had often experienced alteration in their sleep cycle; either had difficulty in falling asleep or lack of sleep. Increased mental stress and poor work ability was reported from a population based survey in Sweden among those who had frequent headaches (Stovner & Andree, 2010). In the present study, it was found that headache had minimal effects on the subjects work ability and mental stress. However, a majority (80%) of them had difficulty in concentrating (see [Table 3]).
| Conclusion | | |
Nursing is a profession that demands mental and physical etiquette while handling patient care activities. Hence, it is very important that headache is taken care or rather prevented from occurring among nurses. Headache being an under-recognized, under-treated and commonly mismanaged disabling group of neuro biological disorders (WHO, 2016), education awareness on headache disorders and their consequences is essential for the nursing staff. Since nurses contribute to the major work force of a hospital, it is important that their physical and mental well-being are provided with adequate attention.
Conflicts of Interest: The authors have declared no conflicts of interest.
| References | | |
| 1. | Bendtsen, L., Evers, S., Linde, M., Mitsikostas, D. D., Sandrini, G., & Schoenen, J. (2010). EFNS guideline on the treatment of tension-type headache. Report of an EFNS task force. European Journal of Neurology, 17(11), 1318-1325.  |
| 2. | International Headache Society. ( 2018). The International Classification of Headache Disorders. Retrieved from https://www.ichd-3.org/ |
| 3. | Kulkarni, G. B., Rao, G. N., Gururaj, G., Stovner, L. J., & Steiner, T. J. (2015). Headache disorders and public ill- health in India: Prevalence estimates in Karnataka State. The Journal ofHeadache and Pain, 16(1), 67. |
| 4. | Lin, K. C., Huang, C. C., & Wu, C. C. (2007). Association between stress at work and primary headache among nursing staff in Taiwan. Headache. The Journal of Head and Face Pain, 47(4), 576-584. |
| 5. | Masoodi, Z. A., Shah, P. A., & Iqbal, I. (2016). Prevalence of headache in Kashmir Valley, India. Neurology Asia, 21(2). |
| 6. | Stovner, L. J., & Andree, C. (2010). Prevalence of headache in Europe: A review for the eurolight project. The Journal ofHeadache and Pain, 11(4), 289. |
| 7. | Stovner, L. J., Hagen, K., Jensen, R., Katsarava, Z., Lipton, R. B., Scher, A. I., & Zwart, J. A. (2007). The global burden of headache: A documentation of headache prevalence and disability worldwide. Cephalalgia, 27(3), 193-210. |
| 8. | Wang, Y., Xie, J., Yang, F., Wu, S., Wang, H., Zhang, X., … & Yu, S. (2015). The prevalence of primary headache disorders and their associated factors among nursing staff in North China. The Journal of Headache and Pain, 16(1), 4. |
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[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4]
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