The burden of headache disorders among medical students in Vietnam: estimates from a cross-sectional study with a health-care needs assessment

Abstract

Background

In our previous study, we demonstrated that headaches are highly prevalent among medical students in Vietnam. In the present study, we provide estimates of the associated symptom burden and impaired participation, utilizing these estimates to assess headache-related healthcare needs within this population.

Methods

The study followed the standardized methodology established by the Global Campaign against Headache. Participants included medical students who were randomly selected from two medical universities in Vietnam. Data collection utilized the HARDSHIP questionnaire, which included diagnostic questions based on ICHD-3 criteria, measures of symptom burden, quality of life (QoL) assessments using the WHOQoL-8, evaluations of impaired participation through the HALT index, and questions about headache yesterday (HY). The definition of health care “need” was based on the likelihood of benefit from intervention, including all participants with probable medication-overuse headache (pMOH), other headaches occurring on ≥ 15 days/month (H15+), migraine on ≥ 3 days/month, or migraine or tension-type headache (TTH) meeting at least one of two criteria related to symptom burden and impaired participation.

Results

A total of 1,362 participants (57.3% female) were included, of whom 1,125 students (61.3% female) were diagnosed with a headache disorder, and 165 students (69.1% female) reported experiencing a HY. The mean frequency of any headache was 3.6 days per month, with an average duration of 5.3 h, and 58% of participants reported an intensity of moderate/severe. For all headache, the mean pTIS was 2.8%. The mean number of lost days over a period of 3 months was 4.3 for work/school tasks, 3.8 for household chore, and 1.7 for social or leisure activities. Among those reporting a HY, 35.8% were able to complete less than half of their expected activities, while 9.7% could complete none. QoL of students with any headache was significantly lower than that of students without headache. A mong students with headache, 43.8% fulfilled atleast one of our needs assessment criteria.

Conclusions

This first study on headache burden in Vietnam reveals substantial symptom burden alongside a correspondingly high level of impaired participation among medical students.

Background

Headache disorders are the most prevalent neurological conditions and rank among the most common health conditions globally, encompassing all causes of disease and injury, and affecting over 3 billion people worldwide [1]. These disorders place a significant burden on individuals, leading to pain, disability, reduced quality of life, and financial challenges, and this burden also affects adolescents and young adults [1, 2]. Studies indicate an increase in the prevalence and disability-adjusted life years (DALYs) associated with migraine and tension-type headache (TTH) from the 1990s to the 2010s, with the highest rates observed in the 20–24 age group, which includes many university students [3]. Medical students, in particular, are vulnerable due to training demands that elevate exposure to headache triggers, affecting up to 40–60% of this group [4, 5].

In a prior study, we reported a 1-year prevalence of headache among Vietnamese medical students as notably high, reaching 82.6% (95%CI: 80.5–84.6) [6]. Prevalence estimates for specific headache types were as follows: migraine at 21.8% (95%CI: 19.6–24.1), TTH at 54.0% (95%CI: 51.3–56.7), probable medication-overuse headache (pMOH) at 0.4% (95%CI: 0.2–1.0), and other headaches occurring on more than 15 days per month at 3.7% (95%CI: 2.7–4.8) [6]. As the first study of its kind conducted in Vietnam, we hope that our findings will contribute to expanding the global understanding of the headache burden. Specifically, the primary objective of this study is to provide detailed estimates of the burdens associated with headaches among Vietnamese medical students, which include both symptom burden and impaired participation. Impaired participation, in this context, refers to lost productivity and withdrawal or disengagement from social activities. The secondary objective is to assess the need for headache-related health care among this population.

Methods

The study’s design, sampling process, and procedures for data collection and management have been thoroughly documented in our prior publication [6]. A brief summary is presented here, with a more detailed description of the study setting and protocol provided in the Supplemental Document.

Study design

This cross-sectional investigation was conducted from March to August 2024 among 1,362 randomly sampled students from Hanoi Medical University (HMU) and the University of Medicine and Pharmacy, Vietnam National University, Hanoi (VNU–UMP), two of the largest medical universities in Vietnam [6, 7]. The research subjects consisted of medical students from HMU and VNU–UMP. Eligible participants were Vietnamese medical students aged 18 years or older. Students who withdrew from the study midway or were unable to complete the data collection process within one week of initiation were excluded. All students who met the eligibility criteria and provided informed consent were included in the study. The study employed standardized methods and a questionnaire developed by the Global Campaign [8, 9]. Interviews were conducted using the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire, which was translated into Vietnamese following a recommended translation protocol [9, 10].

Headache diagnoses

Participants who answered “yes” to the screening question (“Have you had a headache in the last year?”) were subsequently asked diagnostic questions from the HARDSHIP questionnaire [9]. They were instructed to focus on the headache type that was most bothersome to ensure that only one diagnosis was assigned per participant. Diagnoses were made algorithmically according to ICHD-3 criteria in the following order: first, headache on ≥ 15 days/month (H15+), which was categorized into probable medication overuse headache (pMOH) and other H15+; followed by definite migraine, definite tension-type headache (TTH), probable migraine, and probable TTH [9, 11]. Any remaining cases were categorized as unclassified. For analyses, cases of definite and probable migraine, as well as definite and probable TTH, were combined [8]. The detailed diagnostic algorithm is presented in the Supplemental Document.

Headache-attributed burden

Symptom burden

The symptom burden at the individual level was evaluated based on headache frequency, typical duration, and usual intensity. Frequency was reported in days per month, while usual duration was recorded in hours or minutes but analyzed in hours, with both variables treated as continuous. Usual intensity was recorded as a categorical variable with three levels: “not bad” (mild intensity), “quite bad” (moderate intensity), and “very bad” (severe intensity). These intensity levels were further converted into a numerical scale (1 for mild, 2 for moderate, and 3 for severe) to calculate the mean intensity level for each group. The proportion of time spent in an ictal state (pTIS) was calculated by multiplying headache frequency by duration (with duration capped at 24 h, as frequency was recorded in days/month rather than attacks/month) and dividing by the total time (30 days * 24 h). Thus, pTIS is a measure of how much of a person’s time is spent experiencing headache symptoms. Additionally, headache-attributed lost health was estimated for migraine and TTH by multiplying pTIS by the corresponding disability weight (DW) from the Global Burden of Disease study [12]. For participants reporting headache yesterday (HY), duration and intensity were recorded, and pTIS for yesterday was calculated by dividing the HY duration by 24 h.

In addition, we used a set of eight questions developed by the World Health Organization (WHOQoL-8) and incorporated into the HARDSHIP questionnaire to assess the quality of life (QoL) of all participants (with or without headaches). Each question offered five response options corresponding to values from 1 to 5, resulting in a unitless summed score with a possible range of 8–40, which was treated as a continuous variable in the analyses. A higher total scores indicate better QoL. To assess the impact of different types of headaches on the QoL of the students, we compared the mean WHOQoL-8 scores among participant groups categorized by headache types, with the non-headache group serving as the control.

Impaired participation

Impaired participation is a concept proposed and used in several prior studies under the Global Campaign against Headache to describe the extent to which individuals are unable to fully engage in their usual activities due to the impact of headache disorders [9, 13,14,15]. This concept is assessed across various domains of daily life, including work, education, household responsibilities, and leisure activities. In alignment with prior studies, the present study assessed impaired participation at the individual level using two complementary methods. The first method employed the Headache-Attributed Lost Time (HALT) questionnaire, which includes five questions that separately measure productivity loss due to headache across work/school (questions 1 and 2), household tasks (questions 3 and 4), and social or leisure activities (question 5) over the previous three months [16]. These questions were integrated into the HARDSHIP questionnaire, which we utilized, where they correspond to questions 58 to 62 [9]. For work/school and household tasks, days fully missed and those with productivity reduced to less than half were counted as lost days, whereas days with productivity exceeding half were counted as fully productive [16]. For social or leisure activities, the number of days entirely missed due to headache was recorded.

The second method assessed impaired participation on the day prior (“yesterday”) among individuals with HY, without distinguishing between paid or household work and social activities [13, 14]. Participants were asked to respond to question 38 (“Please think about everything you wanted to do yesterday if you had not had a headache. How much of this did you actually do?“) from the HARDSHIP questionnaire [9]. Response options included: everything, more than half, less than half, or nothing achieved yesterday of whatever had been planned. For analysis, responses of “less than half” were treated as equivalent to “nothing achieved,” while responses of “more than half” were treated as equivalent to “everything achieved” to maintain consistency.

To comprehensively assess the overall burden of headache disorders in the study population, measures such as pTIS, lost health, and impaired participation, calculated at the individual level, were further adjusted by the prevalence of each headache type. Independent estimates were made using both 1-year and 1-day prevalence rates. These adjustments aimed to assess the extent to which headache-attributed pTIS, headache-attributed lost health, and impaired participation (as measured by HALT and HY data) were distributed across the entire study population, encompassing both individuals with and without headache. Although the ICHD-3 criteria allow for the diagnosis of individual headache episodes, our study primarily relied on the HARDSHIP questionnaire and, therefore, may be less accurate compared to physician-based diagnoses. Consequently, the HY data in our study was appropriate only for estimating the impact of all headaches collectively, rather than for specific headache types as is typically done with one-year data.

Health-care needs assessment

We defined “need” for health care based on criteria proposed and applied in previous studies, which estimate the number of individuals likely to benefit from medical intervention [13,14,15]. This definition incorporates opinion-based criteria for bothersomeness, potential negative impacts on participation and quality of life, and an anticipated need for prescription medications, including preventive treatments. Accordingly, we included all participants who met at least one of the following criteria: those with H15+, all individuals experiencing migraines on ≥ 3 days per month, and those with migraines or TTH meeting one or both of the following: (1) pTIS > 3.3% and usual intensity ≥ 2 (i.e., moderate-severe); (2) ≥ 3 lost work/school days and/or lost household days in the preceding 3 months.

Statistical analysis

All continuous variables were described using means, standard deviations (SDs), standard errors of the mean (SEMs), medians, and interquartile ranges (IQRs), depending on the distribution. To compare continuous variables between two independent groups (e.g., between male and female groups, or between patients with and without headache), we utilized the Independent t-test when the data were normally distributed, or the Mann-Whitney U test when the data were not normally distributed. For comparisons involving three or more independent groups, we applied the One-way ANOVA for normally distributed data or the Kruskal-Wallis test for non-normally distributed data. If significant differences among the groups were identified using the ANOVA or Kruskal-Wallis test, post-hoc pairwise comparisons were performed using the appropriate Dunnett test. To assess the normality of continuous data, we employed visual methods (histogram, quantile-quantile plot, and boxplot) in conjunction with the Shapiro-Wilk test. Categorical variables were expressed as numbers (percentages) and were compared using the Chi-squared (χ²) test or Fisher’s exact test, as appropriate.

All statistical analysis was conducted by the Stata MP version 18.0 (Stata, College Station, TX, USA). All comparisons were two-tailed, and p < 0.05 were considered statistically significant.

Results

Description of the study population

In the original study, a total of 1,362 participants (57.3% female; mean age 21.1 ± 1.6 years) were surveyed, with a participation rate of 94.7% [6]. Of these, 1,125 participants (82.6%) reported experiencing headaches of any type, with 61.3% of them being female [6]. Specifically, of these participants, 297 (21.8%) were diagnosed with migraine (definite or probable), 736 (54.0%) with tension-type headache (TTH; definite or probable), 6 (0.4%) with probable medication overuse headache (pMOH), and 50 (3.7%) with other H15 + headache types [6]. The prevalence of headache yesterday (HY) was 14.7% (165 students) among those with any headache and 12.1% across the entire study population [6].

Symptom burden

The headache-attributed symptom burden in the study population is presented in Table 1. The average participant-reported frequency of any headache was 3.6 days per month, with a mean participant-reported duration of 5.3 h. 58% of students with headaches reported experiencing at least moderate severity, with 55.7% describing their headaches as moderate and 2.3% as severe, resulting in mean participant-reported usual intensity of 1.6. The average participant-reported proportion of time in the ictal state (pTIS) for any headache was estimated to be 2.8%.

For migraine, the mean participant-reported frequency was 3.0 days per month, with an average participant-reported duration of 7.9 h, and a mean participant-reported proportion of time in the ictal state (pTIS) of 3.1%. On the oher hand, tension-type headache (TTH) had a mean participant-reported frequency of 2.5 days per month), a mean participant-reported duration of 4.0 h, and a mean participant-reported pTIS of 1.3%.

Table 1 Symptom burden by headache type and sex

For the H15 + group, both pMOH and other H15 + exhibited high participant-reported frequencies (mean frequencies of 18.5 and 18.0 days/month, respectively). Moreover, the mean participant-reported durations were 3.9 h for pMOH and 6.4 h for other H15+, resulting in mean participant-reported pTIS values of 9.6% and 15.8%, respectively.

Female participants showed a significantly higher average participant-reported frequency of any headache, migraine, and tension-type headache (TTH) compared to male participants (4.0 vs. 3.0 days per month, p < 0.001, 3.2 vs. 2.7 days per month, p = 0.008, and 2.7 vs. 2.3 days per month, p = 0.008, respectively). Consequently, they also exhibited a significantly higher participant-reported proportion of time in ictal state (pTIS) for migraine and TTH than males (median pTIS: 1.4% vs. 0.8%, p = 0.021; and 0.4% vs. 0.3%, p = 0.049, respectively). The remaining characteristics of symptom burden across the various headache types showed no statistically significant differences between the sexes (p > 0.05).

Impaired participation

Participants with migraine reported an average loss of 4.5, 4.1, and 2.2 days from work/school, household duties, and social or leisure activities, respectively, in the preceding 3 months (Table 2). For TTH, the average participant-reported days lost were at 3.1, 2.6, and 1.2 days over the same period. When considering all students with any headache, the average participant-reported time lost across these three domains was 4.3, 3.8, and 1.7 days, respectively. There were statistically significant differences in the number of lost days for work, household, and leisure across the four headache types (migraine, TTH, pMOH, and other H15+), with p = 0.0001 for all three domains. (Table 2; Fig. 1). On the other hand, no significant differences were observed between males and females in the number of days lost across the three domains among participants with all types of headaches (Table 2).

Table 2 Headache-attributed impaired participation from HALT data by headache type and sex

Fig. 1

Headache-attributed impaired participation by headache type (error bars: 95% confidence interval; pMOH: probable medication-overuse headache; H15 + : headache on ≥ 15 days/month; TTH: tension-type headache)

Headache yesterday

Table 3 presents the symptom burden and impaired participation associated with HY (N = 165). The overall mean duration was 4.4 h, corresponding to a pTIS of 18.3%, with a mean intensity of 1.3 (mild to moderate). Notably, just over half of those with HY were able to perform as usual (26.1%) or more than half of their typical activities (28.5%) (Table 3). No significant differences were found between the sexes in any of these measures (p > 0.05).

Table 3 Symptom burden and impaired participation attributed to headache yesterday

Quality of life

Figure 2 presents the self-reported quality of life (QoL) according to headache status. The results revealed that participants with headaches had significantly lower WHOQoL-8 scores compared to those without headaches (mean score: 26.9 vs. 27.7, p = 0.0265). Additionally, pairwise comparisons between headache types (detailed results are presented in the Supplemental Document) showed that the WHOQoL-8 scores for participants with migraine (mean 27.0) and TTH (mean 27.1) were comparable (p > 0.05) but significantly lower than those for participants with other H15 + headache (mean 24.3) (p < 0.05).

Fig. 2

Mean self-reported quality of life (measured by WHOQoL-8) by headache status (Data are expressed as mean ± SEM; error bars: 95% confidence intervals; pMOH: probable medication-overuse headache; H15 + : headache on ≥ 15 days/month; TTH: tension-type headache; SEM: standard error of the mean)

Study population estimates

The estimated pTIS for (any) headache, adjusted for the overall prevalence in the study population, was 2.3% based on the 30-day recall and 2.7% based on HY (Table 4). Migraine and TTH accounted for the highest proportions of time affected (0.7% for each type). The mean health loss for the overall study population attributed to migraine was 1.41%, while for TTH it was 0.06% (Table 1). Table 4 also presents the estimated impaired participation across the entire study population. Using HALT data, all headaches led to an average loss of 3.6 workdays, 3.1 household days, and 1.4 social or leisure days over the preceding 3 months. On the other hand, overall study population estimate based on HY data indicated a total impaired participation rate of 5.5%. This means that among participants (with or without headache), approximately 5.5% were estimated to experience significant impairment in participation (defined as being unable to perform any tasks or only being able to do less than half of the tasks they intended to do the previous day).

Table 4 Proportion of time in ictal state and impaired participation in the overall study population by headache type and by timeframe of enquiry

Health-Care needs assessment

A total of 597 students, representing nearly half (43.8%) of all participants in this study, met at least one of the six criteria in our needs assessment framework (Table 5). Among these, the proportion of students with migraine or TTH who were likely to benefit from health care was 76.8% and 42.5%, respectively. When applying only the criteria of experiencing headaches on ≥ 15 days per month or migraines on ≥ 3 days per month, 235 participants (17.3%) met at least one of these indicators.

Table 5 Health-Care needs assessment

Discussion

To our knowledge, this is the first study to report on the burden of headache disorders in Vietnam. The study uses data collected concurrently from the same population as our recently published paper on the prevalence of headache disorders among medical students [6]. Although our study was conducted on a specific population and may not be fully representative of the general population in Vietnam, its findings provide valuable insights that contribute to the growing body of evidence on the burden of headache disorders, both within Vietnam and globally.

The analysis of symptom burden revealed that the average participant-reported headache frequency was 3.6 days per month, consistent with findings from previous studies conducted in Mali (3.5 days/month) [17] and Nepal (3.8 days/month) [18]. However, this frequency was lower compared to studies in Saudi Arabia (4.3 days/month) [14], Cameroon (6.7 days/month) [13], and Mongolia (7.0 days/month) [15]. The mean duration of any headache in our study was 5.3 h, which is shorter than that of studies conduted in Saudi Arabia (8.4 h) [14], Mongolia (11.2 h) [15], and Cameroon (13.0 h) [13]. In the present study, 58% of students with headaches in the past year reported experiencing at least moderate severity, with a mean intensity of 1.6 (mild to moderate on a scale of 1–3), which is similar to that reported in Mongolia (mean intensity of 1.5) [15] but slightly lower than the mean intensities reported in Nepal (2.1) [18], Saudi Arabia (2.3) [14], and Cameroon (2.3) [13]. Additionally, the estimated pTIS indicated that symptoms accounted for an average of 2.8% of the total time among students with headaches. This figure is lower compared to estimates reported in Saudi Arabia (3.6%) [14], Mongolia (9.7%) [15], and Cameroon (9.8%) [13]. The differences observed between this study and previous research may be attributed to several factors. Methodological variations, including differences in sampling techniques, as well as environmental factors such as climate, pollution, and geographical location, could contribute to these disparities [6]. Additionally, sociodemographic variables, including race, age, and sex, along with variations in socioeconomic status, may influence susceptibility across populations [6].

The mean headache-attributed health loss were 1.41% for migraine and 0.06% for tension-type headache (TTH), which is comparable to the estimates reported in Saudi Arabia (1.5% and 0.0%, respectively) [14] and Cameroon (2.05 and 0.1%, respectively) [13]. This can be interpreted as the intermittent symptoms of migraine and TTH being equivalent to a continuous health diminution of 1.41% and 0.06%, respectively. However, these values do not align with the lost productivity adjusted by prevalence estimates for migraine (mean of 4.5 work/school days and 4.1 household days over 3 months) and for TTH (mean of 3.1 work/school days and 2.6 household days over 3 months). This discrepancy has also been observed in several prior studies and may be attributed to several factors, including the potential underestimation of headache-attributed health loss or the influence of additional factors contributing to productivity loss beyond the direct health impact of headaches [13,14,15]. Moreover, premonitory, postdromal, or interictal symptoms, along with headache severity, are not considered in the estimation of lost health, which relies solely on pTIS, a measure that only assesses the duration of headache episodes [14, 19,20,21,22].

Lost productivity, adjusted for the prevalence in the study population, indicated that, on average, each medical student (with or without headache) lost 3.6 days over a 3-month period from work or school. The estimated productivity loss for household tasks was approximately 3.1 days per 3 months, while withdrawal from social or leisure activities accounted for around 1.4 days per 3 months. These findings are comparable to those reported in studies from Saudi Arabia (2.5, 3.6, and 1.3 days per 3 months, respectively) [14] but higher than those reported in Cameroon (2.5, 2.2, and 0.6 days per 3 months, respectively) [13] and Mongolia (0.8, 1.4, and 0.3 days per 3 months, respectively) [15]. Impairment in household work prevented students from completing essential daily chores, while reduced participation in social or leisure activities left mental and physical needs unmet, potentially contributing to increased stress and other psychological issues. These negative effects, combined with the direct reduction in work or school time due to headache disorders, contribute to a significant decline in productivity among medical students, a group that requires substantial time for study, research, and clinical training. In our study, pMOH and H15 + were more responsible for lost productivity at the individual level compared to migraine and TTH, but they exhibited only a minor impact at the overall population level in the study. This is attributed to their much lower prevalence relative to the other two headache types. Sex differences in days lost between male and female students were minimal in our study, aligning with findings from previous [13,14,15]. Furthermore, these results are consistent with recent trends in Vietnam, where government and community organizations have actively promoted and implemented initiatives to advance sex equality in both work and education.

While HALT data enables a detailed assessment of impaired participation across three domains, it is limited by the absence of an overall participation estimate. A straightforward approach to estimating total impaired participation would involve summing the mean days lost across the three domains (3.6 + 3.1 + 1.4 = 8.1) and dividing by the total number of days in the last three months (8.1/90 = 9.0%); however, this method may lack accuracy [14]. For example, on weekdays (Monday through Friday) with prolonged headache episodes, both work/school and household time may be affected, while on weekends (Saturday or Sunday), headaches may impact household time as well as social/leisure activities. Consequently, participants might count a single day as lost in 2 or even 3 domains. To address this limitation, we incorporated additional impaired participation estimates from HY data (5.5%), yielding a slightly lower result that may reflect an overestimation in the HALT data due to the aforementioned factors. Using both HALT and HY data thus mitigates the individual methodological limitations, providing a more comprehensive understanding of the impaired participation burden of headache disorders within this population [14].

Although the WHOQoL-8 scale was not specifically designed to assess quality of life in patients with headache disorders, it remains valuable for a comprehensive evaluation of symptom burden and impaired participation in this population. In our study, students were diagosed headache were associated with significantly lower QoL compared to students without headaches (WHOQoL-8 mean score: 26.9 vs. 27.7, p < 0.05). In addition, students with other H15 + headache types demonstrated considerably lower average quality of life scores than those with migraine or TTH. These findings, in conjunction with similar results from studies conducted in Mongolia, Cameroon, and Ethiopia, further highlight the significant negative impact of the symptom burden associated with the H15 + group on quality of life [13, 15, 23]. Notably, in our study, the quality of life (QoL) among patients with migraine and tension-type headache (TTH) was nearly identical, with mean WHOQoL-8 summed scores of 27.0 and 27.1, respectively. This finding aligns with results from previous studies conducted in Ethiopia [23], where the mean WHOQoL-8 summed scores for migraine and TTH were 29.5 and 29.3, respectively, and in Cameroon [13], where both headache types had a mean score of 28.0.

Based on established criteria proposed and employed in previous studies to assess health-care needs, nearly half (43.8%) of students in this study were identified as “in need” or likely to “derive substantial benefit” from active headache management and care. These results are slightly higher than those reported in previous studies that applied the same criteria, including those conducted in Saudi Arabia (35.8%) [14], Mongolia (33.2%) [15], and Cameroon (37.0%) [13]. Specifically, in our study, 17.3% of participants met criteria for having headaches on ≥ 15 days per month (pMOH or other) or migraines on ≥ 3 days per month, both conditions indicative of severe symptom burden and widely accepted as thresholds for preventive medication [14, 24]. An additional 26.5% of students met the remaining four criteria (migraine or TTH with pTIS > 3.3% and moderate-to-severe intensity, or migraine/TTH with ≥ 3 days lost from work and/or household duties over the last 3 months), reflecting further health-care needs. Although these latter criteria may seem less stringent than the former, their presence still suggests a meaningful symptom burden with a notable impact on students’ lives, highlighting the necessity for timely, specialized care for this population [14, 15].

Study strengths and limitations

As previously noted, this study’s strengths include its use of a standardized methodology and questionnaire, a adequate sample size, and a high participation rate (94.7%) [6]. Nonetheless, a primary limitation is the inherent reliance of all cross-sectional retrospective studies on participants’ recall, which may introduce recall bias. Furthermore, this study exclusively included medical students, primarily aged 18–24, representing a population with higher educational levels. This demographic specificity limits the generalizability of our findings to the broader population. Additionally, diagnoses were based solely on participants’ self-reported responses, rather than objective measures such as medical records or clinical interviews, which introduces the potential for bias.

Conclusions

This first study on the burden of headache disorders in Vietnam highlights a significant symptom burden among medical students, with 58% of those experiencing headaches reporting at least moderate severity. On average, these students spent 2.8% of their total time affected by headaches. Additionally, the burden of impaired participation was substantial, with each student reporting an average loss of 4.3 work/school days and 3.8 household days per 3-month period. Furthermore, the QoL among students with headaches was significantly lower compared to those without headaches. Notably, an estimated 43.8% of this medical student population has a headache disorder that could potentially benefit from healthcare intervention.