Associations Between the Presence of Primary Headaches and Quality of Life in University Students

Background and Objectives: Headaches have become one of the global public health burdens in the 21st century. Although findings on the presence of headaches in general and older adult populations have been well-documented, little evidence has been observed for university students. Moreover, their level of quality of life seems to be impaired due to stressful events and the inability to cope with them. However, the mutual relations between headaches and quality of life in this population remain unknown. Therefore, the main purpose of the study was to examine the associations between lifetime headaches and the presence of headaches in the last 12 months with quality of life. Materials and Methods: In total, 1350 university students (age = 22.9 ± 2.3 years; 81.3% female) were recruited. Each participant was instructed to fulfill the Headache-Attributed Restriction, Disability, Social Handicap, and Impaired Participation (HARDSHIP) questionnaire, a reliable and valid tool to assess headache and quality-of-life characteristics. Headache characteristics, headache-related disability (HALT-90), and quality-of-life domains were analyzed using Spearman's correlation analyses and structural equation modeling. Results: Participants with migraine reported more frequent and more intense headaches and substantially greater headache-related disability compared with those with tension-type or undifferentiated headache. The mean number of lost days in the previous 90 days (HALT-90) was 14.3 (SD 23.1) in the migraine group compared with 4.53 (SD 12.0) in the tension-type headache group and 5.77 (SD 10.9) in the undifferentiated headache group. Across most WHOQOL domains, students with migraine reported lower quality-of-life scores compared with other headache groups. The WHOQOL-8 total score averaged 30.9 (SD 4.79) in the migraine group and 33.6 (SD 3.93) among participants without headache. Greater headache burden was consistently associated with poorer quality of life, with headache-related disability showing the strongest correlation with energy for everyday life (r = -0.345, p < 0.001). Conclusions: These findings suggest that greater headache burden, particularly migraine and headache-related disability, is associated with poorer quality of life among university students. The results highlight the need for targeted prevention programs aimed at helping students manage stress more effectively and improve their quality of life.