Neuroepidemiology study of headache in the region of Jammu of north Indian population

Neuroepidemiology study of headache in the region of Jammu of north Indian population | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Neuroepidemiology study of headache in the region of Jammu of north Indian population Amrit Sudershan, Mohd Younis, Aghar Chander Pushap, Hardeep Kumar, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1894878/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Headache disorders represent a major public health problem globally. It is more in developing countries with the rising trends in young adults affecting negatively their quality of life. There has been very little information on the epidemiology of headache disorder in the Jammu division of the north Indian population. Aim The present study is aimed to find out the prevalence of headache and its two major types i.e., migraine and TTH (Tension-Type Headache) in population of Jammu division. Methods The study was conducted in two phases: (Phase I: Face-face interview and Phase II: E-based sampling) and sufferers of headaches were incorporated into the study based on the ICHD-3 criteria for a representative sample. Frequency distribution and mean ± SD were used in descriptive statistics to describe the data sets, while a t-test, chi-square test, and a logistic regression model using odds ratio were used in inferential statistics. Results A total of 3,148 subjects were recruited and found the overall prevalence of headache was 53.84% with a female preponderance (38.18%) in comparison to male 15.66%. Regarding the type, migraine was found to be highly prevalent (33.25%) type than TTH (20.58%). Female suffering from migraine shows the highest prevalence (25.28%). Regarding the environmental factors, bright light OR: 5.81, 95% CIs [4.96–6.81] loud sound OR: 5.17, 95% CIs [4.44–6.03], stress OR: 3.58, 95% CIs [3.07–4.17], empty stomach OR: 3.42, 95% CIs [2.93–3.98] increases the likely hood of the diseases. Also, high comorbidity association was found in between PCOS OR: 8.63, 95% CIs [3.95–18.85], panic disorder OR: 5.04, 95% CIs [1.94–3.05], anxiety OR: 4.53, 95% CIs [3.90–5.27], IBS OR: 3.80, 95% [1.76–8.23] with headache. Conclusion The prevalence of headache is high in the Jammu division of J&K India with migraine being the high prevalent type. Light and sound with high intensity, empty stomach, stress, and less water intake are some highly associated environmental risk factor that increases the severity diseases. Headache Prevalence Jammu North India Migraine Tension Type Headache Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 1. Introduction Headache is the most common, painful, expensive, and stressful condition in the world and is mentioned as the third topmost disabling disease after low back pain and depressive disorder ( Steiner et al., 2020 ). The two most prevalent neurological disorders associated with primary headaches are migraine and tension-type headaches (TTH). Global Burden Disorder- 2019 (GBD-2019) has shown that Italy shows the maximum frequency of prevalent cases per year i.e., 49.02% followed by Norway (47.98%) and Belgium (47.64%). Developed nation like USA, Russia, UK and Germany shows the prevalent rate of about 42,780.87, 40,971.76, 42,509.08 and 43,855.96 prevalent cases per 100,000 (GBD Compare | IHME Viz Hub (healthdata.org). According to the Global Burden of Disease research-2019, headache disorders were the third most frequent cause of disability out of 369 diseases and injuries ( Global Burden of Disease-2019 ). Headache has covered a significant portion of global public health issues ranging from impeding everyday functioning, loss of productivity, increasing financial burdens, and restricting social contact ( Wilkes et al. 2021 ). Adolescents have higher rates of all types of headaches than younger children which negatively impacts their school activities, future life, and family life ( Luvsannorov et al., 2020 ). It has been estimated that only migraine considerably causes low efficiency of job productivity with greater absenteeism and presenteeism, impairment in daily activities as well as more visits to healthcare providers. All of these significantly correlated with the cause of higher economic loss ( Igarashi et al., 2020 ; Wong et al., 2020 ; Buse et al., 2020 ). It has been estimated that presenteeism alone costs are estimated to be over US $ 1296, which is higher than absenteeism costs (US $ 370) ( Wong et al., 2020 ). Although the prevalence of headache is an important epidemiologic measure and understanding the prevalence, risk factors associated with headache in populous nations like India is essential to comprehend the entire scope of the headache burden. This may have a positive impact on upcoming disease prevention and health promotion programs as well as present national or local initiatives that can benefit the healthcare system. Some studies have been conducted in different regions of India including south India and eastern India (Kulkarni et al., 2015 ; Ray et al., 2017 ) including in the Kashmir division of Jammu & Kashmir (UT) (Malik et al., 2012 ; Masoodi et al., 2016 ). But, due to the lack of headache-related studies in the division of Jammu (north Indian population), it is hard to determine how common headache issues are in the population. Therefore, in the current study was aimed to find out the prevalence of the headache condition and its two major types including migraine and TTH in the region of the Jammu Division ( Location : 32.73° N and 74.87° E) of the north Indian population. In addition, we evaluated the multiple environmental factors/lifestyles which may enhance the likelihood of headaches and many disorders associated with headaches, i.e., comorbidity. This is the first attempt of survey-based research in the Jammu division; hence, this insight shall provide the foundation for future research. 2. Material & Method 2.1. Sample Selection In this survey-based epidemiological study, subjects were enrolled using a random sampling method from the Jammu division of the north Indian population, from February 2021 to April 2022. The sampling process was done in two phases, wherein phase-I, using the approach of simple random sampling, subjects were enrolled from the Jammu population by face-face interview. Each participant was briefed about the research procedure and informed consent was obtained. But due to the COVID-19 pandemic and lockdown measures, we used E-based sampling via email with the aid of Google form (Phase II). Data collected from the E-based method was cleaned before merging with data collected from the face-to-face interview. All the incomplete data from the participants were excluded by our two authors (A.C.P & S.S). The inclusions of migraine patients from the representative participants were based on the criteria of the International Classification of Headache Disorders - ICHD-3. Questionnaires were designed according to the ICHD-3 to diagnose the headache and its types including migraine and tension-type headaches and their features among the Jammu population. The strategy or schematic concept for selecting the sample and use of ICHD-3 criteria is depicted in the ( Fig. 1 ). 2.2. Statistical analysis For the descriptive data analysis of variables, mean ± standard deviation and frequency distribution were utilized for the continuous and discrete variables respectively. To find out the significant difference between the continuous variable and discrete variable, t-test and chi-square analysis were used. To establish the significant association between the environmental risk attribute and the headache, a logistic regression model using an Odds ratio (OR) with 95% confidence interval (CIs) and a p-value with < 0.05 was used. All the calculation was done using the free online statistical software including T-test calculator (graphpad.com), Chi-Square Calculator 2x2 (socscistatistics.com), and MedCalc's Odds ratio calculator. For the presentation of the association value/ OR value, “Edge weighted spring embedded layout” was used to draw the association, and Cytoscape: An Open-Source Platform for Complex Network Analysis and Visualization was utilized to draw the structure. 3. Result 3.1. Demography characteristics A total of 3,148 subjects (24.87 ± 10.32) representing the male 1223 (38.85%) and female 1925 (61.14%) with a mean age of 25.73 ± 11.55 and 24.32 ± 9.42 respectively were included. The difference between the mean age was found to be extremely statistically significant (p value = 0.0002) and the observed difference was due to chance. The participants included were from different regions of the Jammu division, where many were seen from the Jammu district (37.26%), Kishtwar (17.24), Kathua (13.18%) Udhampur (10.10%) ( Fig. 2 A ). Regarding the marital status of the participants, the majority were found un married (79.86%) (Fig. 2 B) and concerning the occupation status of the participants, the majority were found to be students with (77.22%) ( Fig. 2 C ). It seems that the subjects mostly favor the mixed dietary pattern including the veg and non-vegetarian, but between veg and non-vegetarian many were found to prefer the non-vegetarian diet (27.98%) (Fig. 2 D). Intake of water (measured in liters) was also observed where it was found that 31.16% of participants take 2liter of water per day and more than 5 liters only 3.04%. ( Fig. 2 E ). Other lifestyle factor estimates including smoking, alcohol, and physical activity were presented in ( Fig. 2 F ). The detailed demographic features and frequency distribution of the participants is presented in ( Table 1 ). Table 1 Frequency distribution of demographic features variable Grouping Total (n) (%) Male (n) (%) Female (n) (%) Sample size N/A 3148 1223 1925 Calculation N/A n/3148*100 n/1223*100 n/1925*100 Age 10 to 19 yrs. 1072 (34.05%) 448 (36.63%) 624 (32.41%) 20 to 35 yrs. 1656 (52.60%) 580 (47.42%) 1076 (55.89%) 36 to 55 yrs. 337 (10.70%) 148 (12.10%) 189 (9.81%) 56 to 75 yrs. 84 (2.66%) 47 (3.84%) 37 (1.92%) Marital status Married 633 (20.10%) 274 (22.40%) 359 (18.64%) Unmarried 2514 (79.86%) 948 (77.51%) 1566 (81.35%) Divorce 1 (0.03%) 1 (0.08%) 0 (0%) Occupation Student 2431 (77.22%) 889 (72.69%) 1542 (80.10%) Govt. Job 278 (8.83%) 166 (13.57%) 112 (5.81%) Pvt. Job 211 (6.70%) 156 (12.75%) 55 (2.85%) Retired 12 (0.38%) 12 (0.98%) 0 (0%) House wife 216 (6.86%) 0 (0%) 216 (11.22%) Community Hindu 2273(72.20%) 799 (65.33%) 1474 (76.57%) Muslim 809 (25.69%) 405 (33.11%) 404 (20.98%) Sikh 61 (1.93%) 19 (1.55%) 42 (2.18%) Buddhist 5 (0.15%) 0 (0%) 5 (0.25%) Water intake < 1 l 359 (11.40%) 87 (7.11%) 272 (14.12%) 1 l 649 (20.61%) 218 (17.82%) 431 (22.38%) 2 l 981 (31.16%) 397 (32.46%) 584 (30.33%) 3 l 623 (19.79%) 260 (21.25%) 363 (18.85%) 4 l 273 (8.67%) 129 (10.54%) 144 (7.48%) 5 l 167 (5.30%) 83 (7.78%) 84 (4.36%) > 5 l 96 (3.04%) 49 (4.006%) 47 (2.44%) Diet Veg 1608 (51.08%) 486 (33.73%) 1122 (58.28%) Non-veg 881 (27.98%) 406 (33.19%) 475 (24.67%) Both 659 (20.93%) 331 (27.06%) 328 (17.03%) Caffeine N/A 2237 (71.06%) 855 (69.91%) 1382 (71.79%) Dairy Product N/A 2547 (80.90%) 951 (77.75%) 1596 (82.90%) Junk Food N/A 1546 (49.11%) 542 (44.31%) 1004 (52.15%) Smoking N/A 135 (4.28%) 115 (9.40%) 20 (1.03%) Alcohol N/A 157 (4.98%) 135 (11.03%) 22 (1.14%) 3.2. Prevalence In the present epidemiology study, the prevalence rate of headache was found near 53.84% with a mean age of 24.95 ± 10.06. Representing the total prevalence of males with a mean age of 25.83 ± 11.51, it was nearly 15.66% in compression to females (24.59 ± 9.39) where the rate was high quite 38.18%. After sub-grouping of the “headache diagnosed participants” based on the criteria “where did they belong to?”, the maximum prevalence was observed in the district of Jammu (41.23%) followed by the Kishtwar (16.99%), Kathua (11.44%), and Udhampur district (10.10%). The frequency distribution of headache prevalence is presented in the Jammu & Kashmir map ( Fig. 3 ). We also analyzed the different types of headaches, majorly the migraine “a neurovascular inflammatory disorder”, menstrual migraines/ hormonal headaches, and Tension-type Headache (TTH) (a stress-related headache). We observed that the prevalence of migraine was found 33.25% with males (24.45 ± 10.76) representing the total prevalence of 7.97% and females (24.23 ± 9) near 25.28%. Also, the “mensuration migraine” prevalence of 11.34%. Another headache type that we observed was TTH, where the total prevalence was found near 20.58% with males representing 12.89% and female was 7.68%. Grouping headache subjects on the bases of the “age group”, it was observed that the highest prevalence was found in the age group of 20–35 years (mean age: 23.79 ± 4.03) (young adults) representing 55.28% with female dominance i.e., 75.77% (male:24.22%) ( Table 2 ) . Migraine was found to be more prevalent (58.07%) in the same age group (20–35 years) than TTH (50.77%). But in the middle-aged group (36–55 years), the prevalence of TTH was slightly increased (13.27%) than migraine (9.83%). Table 2 Grouping of headache subjects using different age groups Age Group Mean ± SD Headache (n = 1695) (n) (%) Migraine (n = 1047) (n) (%) TTH (n = 648) (n) (%) 10–19 (Adolescent) 17.65 ± 10.33 Total 532 (31.38%) 315 (30.08%) 217 (33.48%) Male 184 (34.58%) 88 (27.93%) 96 (44.23%) Female 348 (65.41%) 227 (72.06%) 121 (55.76%) 20–35 (YA) 23.79 ± 10.33 Total 937 (55.28%) 608 (58.07%) 329 (50.77%) Male 227 (24.22%) 127 (20.88%) 100 (30.39%) Female 710 (75.77%) 481 (79.11%) 229 (69.60%) 36–55 (MAG) 44.16 ± 10.35 Total 189 (11.15%) 103 (9.83%) 86 (13.27%) Male 65 (34.39%) 26 (25.24%) 39 (45.34%) Female 124 (65.60%) 77 (74.75%) 47 (54.65%) 56–75 (OAA) 61.21 ± 10.39 Total 37 (2.18%) 21 (2.00%) 16 (2.46%) Male 17 (45.94%) 10 (47.61%) 7 (43.75%) Female 20 (54.05%) 11 (52.38%) 9 (56.25%) YA : Young Adults, MAG : Middle Aged Group, OAA : Old Age Group 3.3. Association of environmental risk factors As the study was not restricted to finding the condition prevalence, we also explored the different environmental risk attributes/lifestyle risk attribute which may contribute to the disease’s likelihood. A diverse range of factors was found to be associated with headache which significantly increases the chance of diseases (Fig. 4 ). Stress, an inevitable factor contributes significantly to the likelihood of the diseases with an associated value of OR: 3.58, 95% CIs [3.07–4.17] (p < 0.0001). After analyzing the different forms of stress, educational stress {OR: 3.41 [2.81–4.12] (p < 0.0001)} was found to be more effective than emotional OR: 3.02, 95% CIs [2.38–3.83] (p < 0.0001), and physical stress which include the extreme household work, long working hours, etc. OR: 2.07, 95% CIs [1.42–3.02] (p = 0.0001). Proper sleep is considered a good indicator of a healthy life but a loss of sleep is a major contributor to the risk of various diseases. In this respect, we also found that sleep less significantly impacted the risk of headache (OR: 2.19, 95% CIs [1.83–2.62] (p < 0.0001). Stress causes significant loss of sleep with an association value OR: 2.28, 95% CIs [1.8784–2.7854] (p < 0.0001). We have also observed that headache subjects were significantly associated with the low water intake, including < 1 liter with an association ration of OR: 2.50, 95% CIs [1.97–3.17] (p-value: <0.0001), 2 liter OR: 1.34, 95% CIs [1.13–1.59] (p = 0.007), and 3 liter OR: 1.1, 95% CIs [0.94–1.49] (p = 0.14). Regarding the dietary habit, red meat/ non-vegetarian food was not found to be associated with the risk of headache OR: 1.00, 95% CIs [0.85–1.18] (p = 0.9487), but on the other hand junk food, dairy products (such as milk, curd, ice-creams, etc.) and caffeine intake were found to be significantly associated with the condition with an OR: 1.95, 95% CIs [1.69–2.25] (p < 0.0001), OR: 1.36, 95% CIs [1.14–1.62] (p = 0.0006) and OR: 0.80, 95% CIs [0.70–0.91] (p = 0.0015) respectively. Also, it was observed that an empty stomach increases the risk of the condition by 3.4% (OR: 3.42, 95% CIs [2.93–3.98] (p < 0.0001). Changes in the weather condition have also been found to increase the risk of headaches whereas the hot temperature was found to increase the risk by 2.3% (OR: 2.35, 95% CIs [1.88–2.95] (p < 0.0001). Bright light including bright sunlight, high beam light, flashing/ flickering of light, and sound (loud sound) was found a major risk factor for headache, increasing the risk by OR: 5.81, 95% CIs [4.96–6.81] (p < 0.0001) and OR: 5.17, 95% CIs [4.44–6.03] (p < 0.0001). To this end, a lot of environmental risk factors have been found which are presented in the frequency weighted association graph ( Fig. 3 ) to be significantly associated with the risk of headache. As we know, minimizing the interaction with the environmental risk factor can significantly minimize the risk of headache. 3.4. Comorbidity In the present study we have also explored the comorbidities associated with headache. As a result, different diseases were found such as Hypo Thy (Hypothyroidism). OR: 2.5886, 95% CIs [1.0248–6.5386] (p = 0.0442), IBS (Irritable Bowel Syndrome) OR: 3.8084, 95% [1.7610–8.2360] (p = 0.0007), PCOS (Poly cystic Ovarian Syndrome) OR: 8.6336, 95% CIs [3.9528–18.8570] (p < 0.0001), anxiety OR: 4.5373, 95% CIs [3.9000-5.2787] (p < 0.0001), hypertension (HT) OR: 2.9246, 95% CIs [1.9785–4.3231] (p < 0.0001), depression OR: 1.9363, 95% CIs [1.1651–3.2181] (p = 0.0108), panic disorder (PD) OR: 5.0411, 95% CIs [1.9463–3.0570] (p = 0.0009), uric acid (UA) OR: 4.7390, 95% CIs [1.0487–2.14158] (p = 0.0432). All the comorbidity association presented in the ORs weighted comorbidity graph ( Fig. 5 ) . Significant differences have been found with respect to their frequency in between headache and non-headache. 4. Discussion 4.1. Prevalence rate The Global Burden of Disease (GBD)-2019 has revealed that headache prevalence is much higher in the top economically developed nations, with the greatest prevalence rates being observed in Italy (49.02%) and the USA (45.11%). Regarding the India’s neighbouring countries and the states of India, the highest prevalence has been recorded in Sri Lanka (37.2%) followed by Nepal (35.95) and the states of Sikkim (38.08%) and Goa (35.24%) respectively ( Global Burden of Disease (GBD)-2019 ). In the current study, high headache prevalence estimates were found (Fig. 3 ) which is also consistent with the other epidemiological study conducted in different regions of India. In south India, headache prevalence is 63.9% with a female preponderance of 73% in comparison to male (54.4%), TTH is 34.8% and migraine 25.6% (female:32.4% & male: 18.6%) (Kulkarni et al., 2015 ). In the eastern states of India, headache prevalence was 14.87% where the females were 23.51% and males were 5.44 and migraine was 14.12% (males: 5.35% and 22.16%) (Ray et al., 2017 ). In the north Indian region, different studies have shown that the headache prevalence is 63.9% wherein females were found to be more affected (74.3%) as compared to males (32.6%). Prevalence of migraine was 13.44% with a female preponderance (87.5%) (Nandha et al., 2013). A prospective observational study in the north Indian population found that 67.7% of patients had migraine and 32.2% of patients had tension-type headaches (TTH) ( Sastry et al., 2022 ). In the valley of Kashmir, headache in the pediatric population was observed where the frequency was found at 66.4% with the female at 65.15% and male at 35.85%, Migraine at 26.98%, and TTH at 50.99% (Malik et al., 2012 ). Another group found the headache frequency rate equal to 66.20% (19–45 years) with female dominancy (61.82%) to male (38.18%). In migraine, the total prevalence was found 45.69% with 55.44% in females and 32.0% in males ( Masoodi et al., 2016 ). To this end, the prevalence of headache and its type varies from region to region and this disparity is mighty due to the different sampling approach (simple random, clustered, stratified sampling), different sample size, type of study (population-based/ hospital case-control, cohort), the differing methodology adopted, differences in defining the criteria of headache prevalence (1 year vs. 3 months), coexisting environmental factors, urban/rural differences, or ethnicity of the studied population. 4.2. Environmental risk factors Headaches were strongly connected with concurrent disorders, routine drug use, analgesic use for diseases other than headaches, and a variety of environmental risk variables ( Nieswand et al. 2019 ). In the present study, different environmental factors have been observed which increase the risk of condition significantly ( Fig. 4 ). In the present study, bright light was found significantly (p < 0.0001) associated with headache (OR: 5.81) and various studies have supported the fact that bright light within the range of 450 nm to 578 nm wavelength significantly alter the condition (Drummond, 1986 ; Main et al., 2000 ; Ofovwe & Ofili, 2010 ). Bright light significantly excites the nociceptive neurons in superficial laminae of trigeminal subnucleus caudalis (Vc/C1) mediated by an intraocular mechanism and transmission through the TRG (Trigeminal root ganglion) ( Okamoto et al., 2010 ) and responsible for pain ( Moulton et al., 2009 ). Bright light also modulates the dura-sensitive neurons in the posterior thalamus whose axons are projected extensively across layers I–V of somatosensory, visual, and associative cortices. The cell bodies and dendrites of such dura/light-sensitive neurons were opposed by axons originating from retinal ganglion cells (RGCs), predominantly from intrinsicality photosensitive RGCs (Retinal Ganglion Cells) ( Noseda et al., 2010 ). Other than the classical pathways, a research study has also supported the other non-classical pathway mediated through the melanopsin, a photopigment that underlies subconscious vision, in the trigeminal nerve (Matynia et al., 2016 ). CGRP (Calcitonin Gene Related Peptide), a potent vasodilator has been found to mediate the transfer of bright light stimulus and anti-CGRP or vasoconstrictive agents blocked light-evoked neural activity (Okamoto et al., 2010 ; Navratilova et al., 2019 ). Weather is another interesting risk factor that have been found to be a profound risk attribute of headaches, as we have also observed that different weather conditions significantly increase the likelihood of headaches ( See Result section ). In support of our study, other studies have shown that weather changes act as a trigger for headache onset or the worsening of ongoing headache symptoms (Prince et al., 2004 ). Lower temperature and higher relative humidity have been significantly associated with the onset of a migraine period (Hoffmann et al., 2011 ). Increases and decreases in temperature lead to a significant increase in the number of migraine attacks ( Scheidt et al., 2013 ). Temperature change accounted for 16.5% of the variance in headache incidence in winter and 9.6% in summer ( Yang et al., 2015 ). This high variance is due to the variance for the temperature and sunshine duration, followed by humidity and pressure during cold ( Yang et al., 2011 ). TRPM8 (Transient receptor-potential M8), a cation channel (Na + and Ca ++ ) is the prime candidate for temperature sensation and is expressed in pain sensory neurons ( McKemy et al., 2002 ) Genome-wide association studies (GWAS) have implicated the TRPM8 channel in association migraine ( Hautakangas et al., 2022 ) and it has been found that decreased expression of TRPM8 is associated with a reduced risk for migraine where homozygous carriers of rs10166942[C] were less sensitive to cold pain ( McKemy et al., 2002 ). Stress can be physiological and oxidative wherein physiological stress includes social support, loneliness, marriage status, social disruption, work environment, social status, social integration, etc, and oxidative represents the increased reactive oxygen species and reactive nitrogen species in the blood. Other than oxidative, physiological stress has greatly influenced the headache where it is found that an increase in the stress intensity will increase the headache frequency (Schramm et al., 2015 ). Different forms include occupational stress (Lin et al., 2007 ; Gillespie et al., 2015; Godwin et al., 2016 ), educational stress (Ghorbani et al., 2013 ; Ibrahim et al., 2017 ) have been found to be associated with headaches. Sleep quality is closely linked to headache ( Yokoyama et al., 2019 ), which affects around 30–50% of migraine patients, and is one of the reasons why migraine sufferers are prone to morning headaches because of sleep deprivation. The impact of sleep disturbances increases self-reported pain and leads to a disturbance of the descending pain inhibitory control system ( Lin et al., 2016 ; Negro et al 2020 ). Another important risk factor that was found to be significantly associated with the condition was less water intake ( See Result Section ). In support of our study, various studies have found that water deprivation may play a role in migraine, particularly in prolonging attacks ( Blau et al., 2004 ), and drinking more water resulted in a statistically significant improvement (Price & Burls, 2015 ). This water ingestion provided relief from headache within 30min to 3hr. It is proposed that water deprivation-induced headache is the result of intracranial dehydration and total plasma volume (Popkin et al., 2010 ). Studies have also shown that water intake did not affect the number of headache episodes, but was associated modestly with a reduction in headache intensity and reduced duration of headache ( Spigt et al., 2005 ). Despite such benefits of water intake, it has also been shown that headache is also caused by drinking cold water which is called “ice-water stimulus provoked headache” attributed to ingestion or inhalation of a cold stimulus (Mages et al., 2017 ) and this pain perception is induced by a cold palatal stimulus ( Mattsson, 2001 ; Mages et al., 2017 ). There has been also reported that there has a negative correlation between water intake and the frequency of headaches. (Khorsha et al., 2020 ). The most extensively used psychostimulant substance in the world is caffeine, also known as trimethylxanthine, an alkaloid that occurs naturally in several plants. The current study provides insight into the risk-attribution potential of caffeine by demonstrating its modest risk capability which significantly (p < 0.0001) increases the chance of condition by 1.95fold. In support of our study, population-based cases and controls have found that patients with chronic daily headache (CDH) were more likely overall to have been high caffeine consumers before the onset of CDH ( Scher et al., 2004 ). Also, a prospective cohort study, conducted by Mostofsky and the group found that high levels of caffeinated beverage intake may be a trigger of migraine headaches ( Mostofsky et al., 2019 ). It has also been shown that the sudden cessation of caffeine use after chronic exposures leads to a withdrawal syndrome with headache as a dominant symptom ( Shapiro, 2008 ) , constipation, impaired behavioural and cognitive performance, joint pains, decreased or increased blood pressure, increased heart rate, hand tremor, increased diuresis, and abdominal pain ( Juliano & Griffiths, 2004 ; Meredith et al., 2013). But in contrast to its risk attribution, with intermittent exposure, caffeine may act as a mild analgesic for headache or as an adjuvant for the actions of other analgesics (Shapiro, 2008 ). The doses of 130 mg enhance the efficacy of analgesics in TTH and doses of ≥ 100 mg enhance benefits in migraine ( Lipton et al., 2017 ). It is not recommended to exceed 400–450 mg/day, because chronic repetitive exposures to caffeine increase the risks for the development of analgesic-overuse headache, and chronic daily headache (Hering-Hanit & Gadoth, 2003 ). Caffeine is rapidly and completely absorbed into the bloodstream after oral ingestion, with peak blood levels reached in 30 min to 45 min. Caffeine with a typical half-life of four to six hours is metabolized by the liver and is excreted by the kidneys via urine (Meredith et al.2013) . Caffeine molecules are structurally similar to adenosine and bind to adenosine receptors on the cell surface and act as competitive inhibitors. As the inhibitory effect of caffeine on adenosine receptors, the state of cortical hyperexcitability is established and this increases alertness and improves cognitive function ( Espinosa Jovel & Sobrino Mejía, 2017 ). Also, caffeine releases dopamine and stimulates glucose utilization in the prefrontal cortex and a caudate nucleus respectively which help in positive reinforcement and mediates motor activity and regulate the sleep-wake cycle respectively ( O'Callaghan et al., 2018 ). We also observed that empty stomach/ fasting significantly (p < 0.0001) increases the likelihood of headache by 3.42fold, which is also supported by various epidemiological studies (Bánk & Márton, 2000 ; Abu-Salameh et al., 2010 ). The length of the fasting-induced headache is dependent on the length of the fast and pain is featured as non-pulsating, mild to moderately intense, wide, or centred in the frontal area (Torelli & Manzoni, 2010 ). The fact has also been supported that after a long time if an individual takes a meal, the chance of postprandial fasting-related headaches increases which is featured with episodic in nature, heaviness (AlAmri et al., 2021 ). The proposed mechanism depicts that a network of neurons and astrocytes may collectively depolarize as a result of an imbalance between the excitatory and inhibitory processes set by a lack of glycogen-derived glucose at the start of intensive synaptic activity. Activating pannexin1 channels in neurons and starting parenchymal inflammatory pathways, may stimulate perivascular trigeminal afferents (Dalkara & Kilic, 2013). In addition, dietary habit such as consumption of red meat/ non-vegetarian food was not found significantly ((p = 0.9487) associated with headache but on the other hand junk food, dairy products (such as milk, curd, ice-creams, etc.) significantly associated with the condition with an OR: 1.95, 95% CIs [1.69–2.25] (p < 0.0001), OR: 1.36, 95% CIs [1.14–1.62] (p = 0.0006). Regarding diary products conflicting result have been reported (Mansouri et al., 2020 ) and patients with migraines consumed less milk than people without migraines (Nazari & Eghbali, 2012 ; Rist et al., 2015 ). Enclosing the section, the present epidemiology study has presented a various range of environmental risk attributes that significantly increases the likelihood of headache. Patients with headaches need to be enlightened about the risk factors that contribute to their condition so that they can avoid them and possibly reduce their headache frequency. 4.3. Comorbidities Co-morbidity is another great thing of concern that needs to be thought about and is defined as the presence of two or more chronic conditions at the same time ( Valderas et al., 2009 ). Comorbidity with headache is a common concern, with more than a third of patients seen by primary care physicians having four or more chronic health issues, and a small percentage having more than ten. In the present epidemiological study, various condition has been found to be associated with headache ( Fig. 5 ) . As in the present study, IBS was found to be highly associated with headache {OR: 3.8084, 95% [1.7610–8.2360] (p = 0.0007)}. Different epidemiological research from different parts of the world has shown the high rates of co-existing IBS and headache which supports our research ( Chang & Lu, 2013 ; Lau et al., 2014 ; Mirzaei et al.,2016; Li et al., 2017 ; Kawashima et al., 2020 ; Grover et al., 2021 ). Headache sufferers specifically migraineurs with long headache history and high headache frequency have a higher chance of being diagnosed with IBS. IBS and migraine share some similarities and can alter gut microflora composition and thereby may affect the gut-brain axis and inflammatory status ( Arzani et al., 2020 ). A key neurotransmitter i.e., serotonin plays a role in both conditions, wherein IBS serotonin causes excessive bowel motions, a lot of digestive output, as well as visceral hypersensitivity in the gut, and defective serotonin activity in the central nervous system is responsible for the migraine. ( Camilleri, 2009 ). In addition, individuals with IBS and migraine have been found to have high family aggregation and genetic variations, such as those in the serotonin reuptake transporter gene (5-HTTLPR) ( Schürks et al., 2010 ; Zhang et al., 2014 ). Other than IBS, PCOS was also found to be significantly (p < 0.0001) associated with headache (OR: 8.6336). Different studies have shown that women with PCOS are burdened with multimorbidity which includes hypertension, tendinitis, osteoarthritis, fractures, endometriosis, and importantly migraine ( Glintborg et al., 2015 ; Banday et al., 2022 Kujanpää et al., 2022 ). The PCOS-disease subnetworks were subjected to pathway enrichment analysis and found a substantial relationship between PCOS and other illnesses like hypertension and migraine ( Ramly et al., 2019 ). Other conditions like a nxiety, hypertension, depression, and panic disorder are also comorbid conditions associated with the headache (Muayqil et al., 2018 ; Caponnetto et al., 2021 ; Togha et al., 2022 ) including uric acid and ( Yazar et al., 2021 ) and hypothyroidism ( Lima et al., 2017; Rubino et al., 2019 ; Spanou et al., 2019 ). Increased levels of uric acid and serum cholesterol have been reported to strongly correlate with white matter hyperintensities; this association may be explained by altered endothelial dysfunction and increased attack frequency ( Trauninger et al., 2011 ). Comorbidity of diseases with headaches may be due to several reasons some of which include sharing common pathophysiological mechanisms ( Lauritzen et al., 2011) , common risk factors including the common genetic variants, and common environmental risk factors. Comorbidity with common diseases is mostly concerned with the sharing of common risk attributes which are frequently used whether it is genetic or environmental factors. 5. Conclusion Headache affects millions of individuals across the country and is defined as a complicated neurovascular condition, not merely a simple discomfort. Many different diseases are linked with headaches and a diverse range of environmental, lifestyle and genetics factors have been observed. Therefore, limiting the exposure to environmental factors could decrease the likelihood of occurrence of headache. Hence, the headache is found to be a highly prevalent neurovascular condition among the people of Jammu division of the north Indian population. List Of Abbreviations TTH Tension-type headache GBD Global burden Disorder UT Union Terr ICHD-3 International Classification of Headache Disorder-3 OR Odds Ratio CIs Confidence Interval IBS Irritable Bowel Syndrome PCOS Polycystic Ovarian Syndrome USA United States of America TRG Trigeminal root ganglion RGCs Retinal Ganglion Cells CGRP Calcitonin Gene-Related Peptide TRPM8 Transient receptor-potential M8 GWAS Genome-Wide Association study Declarations Statement of Ethics: The present study design was duly approved by the Institutional Ethical Committee (IEC), University of Jammu vide notification number EC: DRS/22/4969) and Institutional Ethics Committee, Government Medical College, Jammu (ECR/454/Inst/JK/2013/RR-20). Consent to participate: Data was done after having informed written consent from each study participant. Consent for publication: Not applicable Data Availability Statement: The data from the current study is unavailable to the public due to restrictions. Interested researchers should contact Dr. Parvinder Kumar ( [email protected] ) who oversaw the data collection. Conflict of Interest Statement: The authors declare that they have no conflict of interest. Funding Sources: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contributions: Dr. Parvinder Kumar & Amrit Sudershan contribute to the study design, Amrit Sudershan, Dr. Mohd. Younis, Agar Chander Pushap & Srishty Sudershan Conducted the survey, Agar Chander Pushap & Srishty Sudershan helped with data cleaning, Agar Chander Pushap & Amrit Sudershan analysed the data. Amrit Sudershan & Dr. Mohd Younis drafted the manuscript and edited the pictures and table. Dr. Parvinder Kumar & Dr. Mohd. Younis edited the manuscript , Dr. Parvinder Kumar finalize the manuscript. Acknowledgment: Authors are thankful to the Institute of Human Genetics, University of Jammu, Dr. Pragya Khanna (Principal at GLDM Degree College Hiranagar, Jammu, Jammu & Kashmir-UT), Dr. Roopali Fotra (Department of Zoology), Dr. Sanjay Bhagat (Indira Gandhi Govt. Dental College, Jammu, Jammu & Kashmir-UT), Shikha Sharma (Research scholar at Department of Zoology, Lovely Professional University, Phagwara, Punjab) for their valuable support during the sampling period. References Steiner, T. J., Stovner, L. J., Jensen, R., Uluduz, D., Katsarava, Z., & Lifting The Burden: the Global Campaign against Headache (2020). Migraine remains second among the world's causes of disability, and first among young women: findings from GBD2019. The journal of headache and pain, 21 (1), 137. https://doi.org/10.1186/s10194-020-01208-0 GBD 2019 Diseases and Injuries Collaborators (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet (London, England), 396 (10258), 1204–1222. https://doi.org/10.1016/S0140-6736(20)30925-9 Wilkes, M.J., Mendis, M.D., Bisset, L., Leung, F. T., Sexton, C. T., & Hides, J. A. (2021). The prevalence and burden of recurrent headache in Australian adolescents: findings from the longitudinal study of Australian children. The Journal of Headache and Pain, 22(49), 1–13. https://doi.org/10.1186/s10194-021-01262-2 Luvsannorov, O., Anisbayar, T., Davaasuren, M., Baatar, O., Batmagnai, K., Tumurbaatar, K., Enkhbaatar, S., Uluduz, D., Sasmaz, T., Solmaz, E. T., & Steiner, T. J. (2020). The prevalence of headache disorders in children and adolescents in Mongolia: a nationwide schools-based study. The Journal of Headache and Pain, 21(107), 1–9 https://doi.org/10.1186/s10194-020-01175-6 . Igarashi, H., Ueda, K., Jung, S., Cai, Z., Chen, Y., & Nakamura, T. (2020). Social burden of people with the migraine diagnosis in Japan: evidence from a population-based cross-sectional survey. BMJ open, 10(11), e038987. https://doi.org/10.1136/bmjopen-2020-038987 Wong, L. P., Alias, H., Bhoo-Pathy, N., Chung, I., Chong, Y. C., Kalra, S., & Shah, Z. (2020). Impact of migraine on workplace productivity and monetary loss: a study of employees in banking sector in Malaysia. The journal of headache and pain, 21(1), 68. https://doi.org/10.1186/s10194-020-01144-z Buse, D. C., Yugrakh, M. S., Lee, L. K., Bell, J., Cohen, J. M., & Lipton, R. B. (2020). Burden of Illness Among People with Migraine and ≥ 4 Monthly Headache Days While Using Acute and/or Preventive Prescription Medications for Migraine. Journal of managed care & specialty pharmacy, 26(10), 1334–1343. https://doi.org/10.18553/jmcp.2020.20100 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 of headache and pain, 16, 67. https://doi.org/10.1186/s10194-015-0549-x Ray, B. K., Paul, N., Hazra, A., Das, S., Ghosal, M. K., Misra, A. K., Banerjee, T. K., Chaudhuri, A., & Das, S. K. (2017). Prevalence, burden, and risk factors of migraine: A community-based study from Eastern India. Neurology India, 65(6), 1280–1288. https://doi.org/10.4103/0028-3886.217979 Malik, A. H., Shah, P. A., & Yaseen, Y. (2012). Prevalence of primary headache disorders in school-going children in Kashmir Valley (North-west India). Annals of Indian Academy of Neurology, 15(Suppl 1), S100–S103. https://doi.org/10.4103/0972-2327.100030 Masoodi, Z. A., Shah, P. A., & Iqbal, I. (2016). Prevalence of headache in Kashmir Valley, India. Neurology Asia, 21(2). Nandha, R., & Chhabra, M. K. (2013). Prevalence and clinical characteristics of headache in dental students of a tertiary care teaching dental hospital in Northern India. Int J Basic Clin Pharmacol, 2(1), 51–55. Sastry, A. S., Kumar, A., Pathak, A., Chaurasia, R. N., Singh, V. K., Joshi, D., Singh, V., & Mishra, V. N. (2022). The pattern of primary headache in the North India population: a hospital-based study. The International journal of neuroscience, 1–9. Advance online publication. https://doi.org/10.1080/00207454.2022.2075359 Nieswand, V., Richter, M., Berner, R., von der Hagen, M., Klimova, A., Roeder, I., Koch, T., Sabatowski, R., & Gossrau, G. (2019). The prevalence of headache in German pupils of different ages and school types. Cephalalgia, 39(8), 1030–1040. https://doi.org/10.1177/0333102419837156 Drummond, P. D. (1986). A quantitative assessment of photophobia in migraine and tension headache. Headache: The Journal of Head and Face Pain, 26(9), 465–469. Main, A., Vlachonikolis, I., & Dowson, A. (2000). The wavelength of light causing photophobia in migraine and tension-type headache between attacks. Headache: The Journal of Head and Face Pain, 40(3), 194–199. Ofovwe, G. E., & Ofili, A. N. (2010). Prevalence and impact of headache and migraine among secondary school students in Nigeria. Headache: The Journal of Head and Face Pain, 50(10), 1570–1575. Okamoto, K., Tashiro, A., Chang, Z., & Bereiter, D. A. (2010). Bright light activates a trigeminal nociceptive pathway. PAIN®, 149(2), 235–242. Moulton, E. A., Becerra, L., & Borsook, D. (2009). An fMRI case report of photophobia: activation of the trigeminal nociceptive pathway. Pain, 145(3), 358–363. Noseda, R., Kainz, V., Jakubowski, M., Gooley, J. J., Saper, C. B., Digre, K., & Burstein, R. (2010). A neural mechanism for exacerbation of headache by light. Nature neuroscience, 13(2), 239–245. https://doi.org/10.1038/nn.2475 Matynia, A., Nguyen, E., Sun, X., Blixt, F. W., Parikh, S., Kessler, J., … Gorin, M. B. (2016). Peripheral sensory neurons expressing melanopsin respond to light. Frontiers in Neural Circuits, 10, 60. Navratilova, E., Rau, J., Oyarzo, J., Tien, J., Mackenzie, K., Stratton, J., … Porreca, F. (2019). CGRP-dependent and independent mechanisms of acute and persistent post-traumatic headache following mild traumatic brain injury in mice. Cephalalgia, 39(14), 1762–1775. Prince, P. B., Rapoport, A. M., Sheftell, F. D., Tepper, S. J., & Bigal, M. E. (2004). The effect of weather on headache. Headache: The Journal of Head and Face Pain, 44(6), 596–602. Hoffmann, J., Lo, H., Neeb, L., Martus, P., & Reuter, U. (2011). Weather sensitivity in migraineurs. Journal of neurology, 258(4), 596–602. Scheidt, J., Koppe, C., Rill, S., Reinel, D., Wogenstein, F., & Drescher, J. (2013). Influence of temperature changes on migraine occurrence in Germany. International journal of biometeorology, 57(4), 649–654. Yang, A. C., Fuh, J. L., Huang, N. E., Shia, B. C., & Wang, S. J. (2015). Patients with migraine are right about their perception of temperature as a trigger: time series analysis of headache diary data. The journal of headache and pain, 16(1), 1–7. Yang, A. C., Fuh, J. L., Huang, N. E., Shia, B. C., Peng, C. K., & Wang, S. J. (2011). Temporal associations between weather and headache: analysis by empirical mode decomposition. PloS one, 6(1), e14612. McKemy, D. D., Neuhausser, W. M., & Julius, D. (2002). Identification of a cold receptor reveals a general role for TRP channels in thermosensation. Nature, 416(6876), 52–58. https://doi.org/10.1038/nature719 Dussor, G., & Cao, Y. Q. (2016). TRPM8 and migraine. Headache: The Journal of Head and Face Pain, 56(9), 1406–1417. Hautakangas, H., Winsvold, B. S., Ruotsalainen, S. E., Bjornsdottir, G., Harder, A., Kogelman, L., Thomas, L. F., Noordam, R., Benner, C., Gormley, P., Artto, V., Banasik, K., Bjornsdottir, A., Boomsma, D. I., Brumpton, B. M., Burgdorf, K. S., Buring, J. E., Chalmer, M. A., de Boer, I., Dichgans, M., … Pirinen, M. (2022). Genome-wide analysis of 102,084 migraine cases identifies 123 risk loci and subtype-specific risk alleles. Nature genetics, 54(2), 152–160. https://doi.org/10.1038/s41588-021-00990-0 Schramm, S. H., Moebus, S., Lehmann, N., Galli, U., Obermann, M., Bock, E., Yoon, M. S., Diener, H. C., & Katsarava, Z. (2015). The association between stress and headache: A longitudinal population-based study. Cephalalgia: an international journal of headache , 35 (10), 853–863. https://doi.org/10.1177/0333102414563087 Lin, K. C., Huang, C. C., & Wu, C. C. (2007). Association between stress at work and primary headache among nursing staff in Taiwan. Headache , 47 (4), 576–584. https://doi.org/10.1111/j.1526-4610.2007.00759.x Gillespie, N. A., Walsh, M. H. W. A., Winefield, A. H., Dua, J., & Stough, C. (2001). Occupational stress in universities: Staff perceptions of the causes, consequences and moderators of stress. Work & stress , 15 (1), 53–72. Godwin, A., Alex, L., & Selorm, F. H. (2016). Occupational stress and its management among nurses at St. Dominic Hospital, Akwatia, Ghana. Health Science Journal , 10 (6), 0–0. Ghorbani, A., Abtahi, S. M., Fereidan-Esfahani, M., Abtahi, S. H., Shemshaki, H., Akbari, M., & Mehrabi-Koushki, A. (2013). Prevalence and clinical characteristics of headache among medical students, Isfahan, Iran. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences , 18 (Suppl 1), S24–S27. Ibrahim, N. K., Alotaibi, A. K., Alhazmi, A. M., Alshehri, R. Z., Saimaldaher, R. N., & Murad, M. A. (2017). Prevalence, predictors and triggers of migraine headache among medical students and interns in King Abdulaziz University, Jeddah, Saudi Arabia. Pakistan journal of medical sciences , 33 (2), 270–275. https://doi.org/10.12669/pjms.332.12139 Yokoyama, M., Yokoyama, T., Funazu, K., Yamashita, T., Kondo, S., Hosoai, H., Yokoyama, A., & Nakamura, H. (2009). Associations between headache and stress, alcohol drinking, exercise, sleep, and comorbid health conditions in a Japanese population. The journal of headache and pain, 10 (3), 177–185. https://doi.org/10.1007/s10194-009-0113-7 Lin, Y.-K., Lin, G.-Y., Lee, J.-T., Lee, M.-S., Tsai, C.-K., Hsu, Y.-W., Lin, Y.-Z., Tsai, Y.-C., & Yang, F.-C. (2016). Associations Between Sleep Quality and Migraine Frequency: A Cross-Sectional Case-Control Study. Medicine, 95 (17). Negro, A., Seidel, J. L., Houben, T., Yu, E. S., Rosen, I., Arreguin, A. J., Yalcin, N., Shorser-Gentile, L., Pearlman, L., Sadhegian, H., Vetrivelan, R., Chamberlin, N. L., Ayata, C., Martelletti, P., Moskowitz, M. A., & Eikermann-Haerter, K. (2020). Acute sleep deprivation enhances susceptibility to the migraine substrate cortical spreading depolarization. The Journal of Headache and Pain 2020 21:1, 21(1), 1–11. https://doi.org/10.1186/S10194-020-01155-W Blau, J. N., Kell, C. A., & Sperling, J. M. (2004). Water-deprivation headache: a new headache with two variants. Headache, 44(1), 79–83. https://doi.org/10.1111/j.1526-4610.2004.04014.x Price, A., & Burls, A. (2015). Increased water intake to reduce headache: learning from a critical appraisal. Journal of evaluation in clinical practice, 21(6), 1212–1218. Popkin, B. M., D'Anci, K. E., & Rosenberg, I. H. (2010). Water, hydration, and health. Nutrition reviews, 68(8), 439–458. Spigt, M. G., Kuijper, E. C., Schayck, C. P., Troost, J., Knipschild, P. G., Linssen, V. M., & Knottnerus, J. A. (2005). Increasing the daily water intake for the prophylactic treatment of headache: a pilot trial. European journal of neurology, 12(9), 715–718. https://doi.org/10.1111/j.1468-1331.2005.01081.x Mages, S., Hensel, O., Zierz, A. M., Kraya, T., & Zierz, S. (2017). Experimental provocation of 'ice-cream headache' by ice cubes and ice water. Cephalalgia: an international journal of headache, 37(5), 464–469. https://doi.org/10.1177/0333102416650704 Mattsson P. (2001). Headache caused by drinking cold water is common and related to active migraine. Cephalalgia: an international journal of headache, 21(3), 230–235. https://doi.org/10.1046/j.1468-2982.2001.00211.x Khorsha, F., Mirzababaei, A., Togha, M., & Mirzaei, K. (2020). Association of drinking water and migraine headache severity. Journal of clinical neuroscience: official journal of the Neurosurgical Society of Australasia, 77, 81–84. https://doi.org/10.1016/j.jocn.2020.05.034 Scher, A. I., Stewart, W. F., & Lipton, R. B. (2004). Caffeine as a risk factor for chronic daily headache: a population-based study. Neurology, 63(11), 2022–2027. https://doi.org/10.1212/01.wnl.0000145760.37852.ed Mostofsky, E., Mittleman, M. A., Buettner, C., Li, W., & Bertisch, S. M. (2019). Prospective Cohort Study of Caffeinated Beverage Intake as a Potential Trigger of Headaches among Migraineurs. The American journal of medicine, 132(8), 984–991. https://doi.org/10.1016/j.amjmed.2019.02.015 Juliano, L. M., & Griffiths, R. R. (2004). A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features. Psychopharmacology , 176 (1), 1–29. https://doi.org/10.1007/s00213-004-2000-x Juliano, L. M., & Griffiths, R. R. (2004). A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features. Psychopharmacology , 176 (1), 1–29. https://doi.org/10.1007/s00213-004-2000-x Shapiro, R. E. (2008). Caffeine and headaches. Current pain and headache reports, 12(4), 311–315. Lipton, R. B., Diener, H. C., Robbins, M. S., Garas, S. Y., & Patel, K. (2017). Caffeine in the management of patients with headache. The journal of headache and pain, 18(1), 107. https://doi.org/10.1186/s10194-017-0806-2 Hering-Hanit, R., & Gadoth, N. (2003). Caffeine-induced headache in children and adolescents. Cephalalgia: an international journal of headache, 23(5), 332–335. https://doi.org/10.1046/j.1468-2982.2003.00576.x Espinosa Jovel, C. A., & Sobrino Mejía, F. E. (2017). Caffeine and headache: specific remarks. Cafeína y cefalea: consideraciones especiales. Neurologia (Barcelona, Spain), 32(6), 394–398. https://doi.org/10.1016/j.nrl.2014.12.016 O'Callaghan F, Muurlink O, Reid N. Effects of caffeine on sleep quality and daytime functioning. Risk Manag Healthc Policy. 2018;11:263–271. Bánk, J., & Márton, S. (2000). Hungarian migraine epidemiology. Headache , 40 (2), 164–169. https://doi.org/10.1046/j.1526-4610.2000.00023.x Abu-Salameh, I., Plakht, Y., & Ifergane, G. (2010). Migraine exacerbation during Ramadan fasting. The journal of headache and pain , 11 (6), 513–517. https://doi.org/10.1007/s10194-010-0242-z Torelli, P., & Manzoni, G. C. (2010). Fasting headache. Current pain and headache reports , 14 (4), 284–291. https://doi.org/10.1007/s11916-010-0119-5 AlAmri, A., AlMuaigel, M., AlSheikh, M., Zeeshan, M., Suwayyid, W., & AlShamrani, F. (2021). Postprandial fasting related headache during Ramadan in Saudi Arabia: A cross-sectional study. Cephalalgia: an international journal of headache , 41 (11–12), 1201–1207. https://doi.org/10.1177/03331024211017915 Dalkara, T., & Kiliç, K. (2013). How does fasting trigger migraine? A hypothesis. Current pain and headache reports , 17 (10), 368. https://doi.org/10.1007/s11916-013-0368-1 Valderas, J. M., Starfield, B., Sibbald, B., Salisbury, C., & Roland, M. (2009). Defining comorbidity: implications for understanding health and health services. Annals of family medicine , 7 (4), 357–363. https://doi.org/10.1370/afm.983 Chang, F. Y., & Lu, C. L. (2013). Irritable bowel syndrome and migraine: bystanders or partners?. Journal of neurogastroenterology and motility , 19 (3), 301. Lau, C. I., Lin, C. C., Chen, W. H., Wang, H. C., & Kao, C. H. (2014). Association between migraine and irritable bowel syndrome: A population-based retrospective cohort study. European Journal of Neurology , 21 (9), 1198–1204. Mirzaei, S., Khorvash, F., Ghasemi, M., Memar-Montazerin, S., & Khazaeili, M. (2016). Migraine and irritable bowel syndrome: An epidemiological study. Caspian Journal of Neurological Sciences , 2 (1), 36–41. Li, C., Yu, S., Li, H., Zhou, J., Liu, J., Tang, W., & Zhang, L. (2017). Clinical features and risk factors for irritable bowel syndrome in migraine patients. Pakistan Journal of Medical Sciences , 33 (3), 720. Kawashima, K., Fukuba, N., Uemura, Y., Ota, K., Kazumori, H., Sonoyama, H., Oka, A., Tada, Y., Mishima, Y., Oshima, N., Yuki, T., Katsube, T., Kinoshita, Y., & Ishihara, S. (2020). Comorbid irritable bowel syndrome symptoms and headache have greater association with anxiety than depression: Annual health check-up survey results. Medicine , 99 (47), e23059. https://doi.org/10.1097/MD.0000000000023059 Grover, M., Kolla, B. P., Pamarthy, R., Mansukhani, M. P., Breen-Lyles, M., He, J. P., & Merikangas, K. R. (2021). Psychological, physical, and sleep comorbidities and functional impairment in irritable bowel syndrome: Results from a national survey of US adults. PloS one , 16 (1), e0245323. Arzani, M., Jahromi, S. R., Ghorbani, Z., Vahabizad, F., Martelletti, P., Ghaemi, A., Sacco, S., Togha, M., & School of Advanced Studies of the European Headache Federation (EHF-SAS) (2020). Gut-brain Axis and migraine headache: a comprehensive review. The journal of headache and pain , 21 (1), 15. https://doi.org/10.1186/s10194-020-1078-9 Camilleri M. (2009). Serotonin in the gastrointestinal tract. Current opinion in endocrinology, diabetes, and obesity , 16 (1), 53–59. https://doi.org/10.1097/med.0b013e32831e9c8e Schürks, M., Rist, P. M., & Kurth, T. (2010). 5-HTTLPR polymorphism in the serotonin transporter gene and migraine: a systematic review and meta-analysis. Cephalalgia: an international journal of headache , 30 (11), 1296–1305. https://doi.org/10.1177/0333102410362929 Zhang, Z. F., Duan, Z. J., Wang, L. X., Yang, D., Zhao, G., & Zhang, L. (2014). The serotonin transporter gene polymorphism (5-HTTLPR) and irritable bowel syndrome: a meta-analysis of 25 studies. BMC gastroenterology , 14 , 23. https://doi.org/10.1186/1471-230X-14-23 Glintborg, D., Hass Rubin, K., Nybo, M., Abrahamsen, B., & Andersen, M. (2015). Morbidity and medicine prescriptions in a nationwide Danish population of patients diagnosed with polycystic ovary syndrome. European journal of endocrinology , 172 (5), 627–638. https://doi.org/10.1530/EJE-14-1108 BANDAY, M., WANI, M., FAROOQ, U., PARRA, B., & RATHER, Y. (2020). Sociodemographic and comorbidity profiles of migraine patients: an outpatient-based study in a tertiary care hospital. Asian Journal of Pharmaceutical and Clinical Research , 59–64. Kujanpää, L., Arffman, R. K., Pesonen, P., Korhonen, E., Karjula, S., Järvelin, M. R., Franks, S., Tapanainen, J. S., Morin-Papunen, L., & Piltonen, T. T. (2022). Women with polycystic ovary syndrome are burdened with multimorbidity and medication use independent of body mass index at late fertile age: A population-based cohort study. Acta obstetricia et gynecologica Scandinavica , 101 (7), 728–736. https://doi.org/10.1111/aogs.14382 Ramly, B., Afiqah-Aleng, N., & Mohamed-Hussein, Z. A. (2019). Protein-Protein Interaction Network Analysis Reveals Several Diseases Highly Associated with Polycystic Ovarian Syndrome. International journal of molecular sciences , 20 (12), 2959. https://doi.org/10.3390/ijms20122959 Muayqil, T., Al-Jafen, B. N., Al-Saaran, Z., Al-Shammari, M., Alkthiry, A., Muhammad, W. S., Murshid, R., & Alanazy, M. H. (2018). Migraine and Headache Prevalence and Associated Comorbidities in a Large Saudi Sample. European neurology , 79 (3–4), 126–134. https://doi.org/10.1159/000487317 Caponnetto, V., Deodato, M., Robotti, M., Koutsokera, M., Pozzilli, V., Galati, C., Nocera, G., De Matteis, E., De Vanna, G., Fellini, E., Halili, G., Martinelli, D., Nalli, G., Serratore, S., Tramacere, I., Martelletti, P., Raggi, A., & European Headache Federation School of Advanced Studies (EHF-SAS) (2021). Comorbidities of primary headache disorders: a literature review with meta-analysis. The journal of headache and pain , 22 (1), 71. https://doi.org/10.1186/s10194-021-01281-z Togha, M., Karimitafti, M. J., Ghorbani, Z., Farham, F., Naderi-Behdani, F., Nasergivehchi, S., … Jafari, E. (2022). Characteristics and comorbidities of headache in patients over 50 years of age: a cross-sectional study. BMC geriatrics , 22 (1), 1–10. Yazar, T., Yazar, H. O., Aygün, A., Karabacak, V., Altunkaynak, Y., & Kirbaş, D. (2021). Evaluation of serum uric levels in migraine. Neurological sciences: official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology , 42 (2), 705–709. https://doi.org/10.1007/s10072-020-04598-w Lima Carvalho, M. F., de Medeiros, J. S., & Valença, M. M. (2017). Headache in recent onset hypothyroidism: Prevalence, characteristics and outcome after treatment with levothyroxine. Cephalalgia: an international journal of headache , 37 (10), 938–946. https://doi.org/10.1177/0333102416658714 Rubino, E., Rainero, I., Garino, F., Vicentini, C., Govone, F., Vacca, A., Gai, A., Gentile, S., Govone, G., Ragazzoni, F., Pinessi, L., Giordana, M. T., & Limone, P. (2019). Subclinical hypothyroidism is associated with migraine: A case-control study. Cephalalgia: an international journal of headache , 39 (1), 15–20. https://doi.org/10.1177/0333102418769917 Spanou, I., Bougea, A., Liakakis, G., Rizonaki, K., Anagnostou, E., Duntas, L., & Kararizou, E. (2019). Relationship of Migraine and Tension-Type Headache With Hypothyroidism: A Literature Review. Headache , 59 (8), 1174–1186. https://doi.org/10.1111/head.13600 Trauninger, A., Leél-Ossy, E., Kamson, D. O., Pótó, L., Aradi, M., Kövér, F., Imre, M., Komáromy, H., Erdélyi-Botor, S., Patzkó, A., & Pfund, Z. (2011). Risk factors of migraine-related brain white matter hyperintensities: an investigation of 186 patients. The journal of headache and pain , 12 (1), 97–103. https://doi.org/10.1007/s10194-011-0299-3 Lauritzen, M., & Strong, A. J. (2001). Evidence for CSD or CSD-Like Phenomena in Human Brain in Relation to Migraine and Stroke. Ischemic Blood Flow in the Brain, 335–342. https://doi.org/10.1007/978-4-431-67899-1_41 Mansouri, M., Sharifi, F., Varmaghani, M., Yaghubi, H., Shokri, A., Moghadas-Tabrizi, Y., Keshtkar, A., & Sadeghi, O. (2020). Dairy consumption in relation to primary headaches among a large population of university students: The MEPHASOUS study. Complementary therapies in medicine , 48 , 102269. https://doi.org/10.1016/j.ctim.2019.102269 Nazari, F., & Eghbali, M. (2012). Migraine and its relationship with dietary habits in women. Iranian journal of nursing and midwifery research , 17 (2 Suppl 1), S65–S71. Rist, P. M., Buring, J. E., & Kurth, T. (2015). Dietary patterns according to headache and migraine status: a cross-sectional study. Cephalalgia: an international journal of headache , 35 (9), 767–775. https://doi.org/10.1177/0333102414560634 Additional Declarations No competing interests reported. Supplementary Files Visualabstarctfinal.jpg Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1894878","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":124417130,"identity":"19e79054-4553-4e6e-9329-ed09c310a3de","order_by":0,"name":"Amrit Sudershan","email":"","orcid":"","institution":"University of Jammu","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Amrit","middleName":"","lastName":"Sudershan","suffix":""},{"id":124417131,"identity":"7fbc4659-2821-435f-9f32-e3890f309667","order_by":1,"name":"Mohd Younis","email":"","orcid":"","institution":"Bharathair University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mohd","middleName":"","lastName":"Younis","suffix":""},{"id":124417132,"identity":"c8119c02-11f3-4d58-a76a-e92546ee72c0","order_by":2,"name":"Aghar Chander Pushap","email":"","orcid":"","institution":"University Wing, Dakshina Bharat Hindi Prachar Sabha","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Aghar","middleName":"Chander","lastName":"Pushap","suffix":""},{"id":124417133,"identity":"cf786ba6-3ed5-4192-b5a0-dd6b81c9e655","order_by":3,"name":"Hardeep Kumar","email":"","orcid":"","institution":"Super Speciality Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hardeep","middleName":"","lastName":"Kumar","suffix":""},{"id":124417134,"identity":"2686fda3-86b2-4194-909c-16166747b7c8","order_by":4,"name":"Srishty Sudershan","email":"","orcid":"","institution":"University of Jammu","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Srishty","middleName":"","lastName":"Sudershan","suffix":""},{"id":124417135,"identity":"43cfc32e-a1df-4d1a-b9eb-5e6545a50a51","order_by":5,"name":"Parvinder Kumar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIiWNgGAWjYLCCBAZmBgYeHsYHCQY1ciCBAw+I1MJs8KHimDFYSwJhe8Ba2CRnnGFObIAYghuYs599JvFwh7Wcec/ZA9K8bWzp88MOPwTaYien24Bdi2VPuplE4pl0Y5mzfQnGvG0yuRtvpxkAtSQbmx3ArsXgQBqzQWLb4cQZ/DwGyUBbcjfOTgBpOZC4DZeW88/AWupBWg7ztjGnG85O/4Bfy400xgdALQkSvD2GjUDvJ8hL5+C3xXLGM5CWdMMZPOeSGYCBbLhBOqfgQIIBbr+Y86cxHPzZZi0vwZN7/AcwKuXlZ6dv/vChwk4Op/exBAh2cTxa5Btwqx4Fo2AUjIKRCQDR3mIC57NxowAAAABJRU5ErkJggg==","orcid":"","institution":"University of Jammu","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Parvinder","middleName":"","lastName":"Kumar","suffix":""}],"badges":[],"createdAt":"2022-07-25 17:44:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1894878/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1894878/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":24620063,"identity":"39082d2c-0189-42cc-93bf-a335fb6cea16","added_by":"auto","created_at":"2022-08-01 18:24:17","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":283573,"visible":true,"origin":"","legend":"\u003cp\u003ePictorial representation of the data collection in the present survey\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-1894878/v1/91120d63a04ddd62345e4666.jpeg"},{"id":24620068,"identity":"9a199ee0-f22f-4f73-853b-fb275d20ee1f","added_by":"auto","created_at":"2022-08-01 18:24:17","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":163436,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDemographic infographics: (A): \u003c/strong\u003eDoughnut representing the total subject inclusion from the different parts of the Jammu division \u003cstrong\u003e(B):\u003c/strong\u003e Column graph showing the martial status, \u003cstrong\u003e(C): \u003c/strong\u003eDoughnut graph represent the occupation status of participants, \u003cstrong\u003e(D): \u003c/strong\u003eDietary habit of the participants, \u003cstrong\u003e(E):\u003c/strong\u003e Doughnut diagram shows the frequency of the total water intake in liter by the participants. \u003cstrong\u003e(F): \u003c/strong\u003ePresentation of frequency of different data variable such as “physical activities”, “smoking”, \u0026amp; “alcohol usage”.\u0026nbsp;\u0026nbsp;\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-1894878/v1/008d7722bcbc4a3a392386d4.jpeg"},{"id":24620067,"identity":"f5d825a9-0c17-49d3-bd7b-b0e0c79d1677","added_by":"auto","created_at":"2022-08-01 18:24:17","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":220736,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of Headache in the Jammu region of north Indian population\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-1894878/v1/92fbb8b932e5fee80264f777.jpeg"},{"id":24620065,"identity":"87c178ee-64fb-4eb8-832d-b812a955fa0c","added_by":"auto","created_at":"2022-08-01 18:24:17","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":177449,"visible":true,"origin":"","legend":"\u003cp\u003eEnvironmental risk factor association: [Cytoscape 3.9.2: Weighted network based on measure of strength of association i.e., Odds Ratio: Edges are defined by the OR values depicting the association between different peripheral node and the core node].\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-1894878/v1/3f912d7666eef585cf43b417.jpeg"},{"id":24620064,"identity":"4ba747bf-acda-4473-a6fd-1c57b3dca535","added_by":"auto","created_at":"2022-08-01 18:24:17","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":68828,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComorbidity Weighted association graph:\u003c/strong\u003e \u003cstrong\u003eHypo Thy (Hypothyroidism)\u003c/strong\u003e. OR: 2.5886, 95% CIs [1.0248-6.5386] (p=0.0442), \u003cstrong\u003eIBS\u003c/strong\u003e (Irritable Bowel Syndrome) OR: 3.8084, 95% [1.7610-8.2360] (p=0.0007), \u003cstrong\u003ePCOS \u003c/strong\u003e(Poly cystic Ovarian Syndrome) OR: 8.6336, 95% CIs [3.9528-18.8570] (p\u0026lt;0.0001), \u003cstrong\u003eAnxiety\u003c/strong\u003e OR: 4.5373, 95% CIs [3.9000-5.2787] (p\u0026lt;0.0001), Hypertension \u003cstrong\u003e(HT)\u003c/strong\u003e OR: 2.9246, 95% CIs [1.9785-4.3231] (p\u0026lt;0.0001), Depression OR: 1.9363, 95% CIs [1.1651-3.2181] (p=0.0108), Panic disorder \u003cstrong\u003e(PD)\u003c/strong\u003e OR: 5.0411, 95% CIs [1.9463-3.0570] (p=0.0009), Uric acid \u003cstrong\u003e(UA)\u003c/strong\u003e OR: 4.7390, 95% CIs [1.0487-2.14158] (p=0.0432)\u003cstrong\u003e [Cytoscape 3.9.2: Weighted network based on measure of strength of association i.e., Odds Ratio: Edges are defined by the OR values depicting the association between different peripheral node (Disorder) and the core node i.e., Headache].\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-1894878/v1/9d0ccc053152706aed7cd443.jpeg"},{"id":24835287,"identity":"bcc054b5-b763-4b11-ad78-e74d815053e7","added_by":"auto","created_at":"2022-08-05 14:44:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1052369,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1894878/v1/a1eb955f-b468-47aa-9259-7928d69a9ed8.pdf"},{"id":24620066,"identity":"c2164cda-42c3-45d4-a324-dcfd7490d103","added_by":"auto","created_at":"2022-08-01 18:24:17","extension":"jpg","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":1269755,"visible":true,"origin":"","legend":"","description":"","filename":"Visualabstarctfinal.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1894878/v1/47c93cf07900ffe06ef7ad16.jpg"}],"financialInterests":"No competing interests reported.","formattedTitle":"Neuroepidemiology study of headache in the region of Jammu of north Indian population","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eHeadache is the most common, painful, expensive, and stressful condition in the world and is mentioned as the third topmost disabling disease after low back pain and depressive disorder (\u003cb\u003eSteiner et al., 2020\u003c/b\u003e). The two most prevalent neurological disorders associated with primary headaches are migraine and tension-type headaches (TTH). Global Burden Disorder- 2019 (GBD-2019) has shown that Italy shows the maximum frequency of prevalent cases per year i.e., 49.02% followed by Norway (47.98%) and Belgium (47.64%). Developed nation like USA, Russia, UK and Germany shows the prevalent rate of about 42,780.87, 40,971.76, 42,509.08 and 43,855.96 prevalent cases per 100,000 (GBD Compare | IHME Viz Hub (healthdata.org). According to the Global Burden of Disease research-2019, headache disorders were the third most frequent cause of disability out of 369 diseases and injuries (\u003cb\u003eGlobal Burden of Disease-2019\u003c/b\u003e).\u003c/p\u003e \u003cp\u003eHeadache has covered a significant portion of global public health issues ranging from impeding everyday functioning, loss of productivity, increasing financial burdens, and restricting social contact \u003cb\u003e(\u003c/b\u003eWilkes et al. \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Adolescents have higher rates of all types of headaches than younger children which negatively impacts their school activities, future life, and family life \u003cb\u003e(\u003c/b\u003eLuvsannorov et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). It has been estimated that only migraine considerably causes low efficiency of job productivity with greater absenteeism and presenteeism, impairment in daily activities as well as more visits to healthcare providers. All of these significantly correlated with the cause of higher economic loss \u003cb\u003e(\u003c/b\u003eIgarashi et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Wong et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Buse et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). It has been estimated that presenteeism alone costs are estimated to be over US\u003cspan\u003e$\u003c/span\u003e1296, which is higher than absenteeism costs (US\u003cspan\u003e$\u003c/span\u003e370) \u003cb\u003e(\u003c/b\u003eWong et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough the prevalence of headache is an important epidemiologic measure and understanding the prevalence, risk factors associated with headache in populous nations like India is essential to comprehend the entire scope of the headache burden. This may have a positive impact on upcoming disease prevention and health promotion programs as well as present national or local initiatives that can benefit the healthcare system. Some studies have been conducted in different regions of India including south India and eastern India (Kulkarni et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Ray et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) including in the Kashmir division of Jammu \u0026amp; Kashmir (UT) (Malik et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Masoodi et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). But, due to the lack of headache-related studies in the division of Jammu (north Indian population), it is hard to determine how common headache issues are in the population.\u003c/p\u003e \u003cp\u003eTherefore, in the current study was aimed to find out the prevalence of the headache condition and its two major types including migraine and TTH in the region of the Jammu Division (\u003cb\u003eLocation\u003c/b\u003e: 32.73\u0026deg; N and 74.87\u0026deg; E) of the north Indian population. In addition, we evaluated the multiple environmental factors/lifestyles which may enhance the likelihood of headaches and many disorders associated with headaches, i.e., comorbidity. This is the first attempt of survey-based research in the Jammu division; hence, this insight shall provide the foundation for future research.\u003c/p\u003e"},{"header":"2. Material \u0026 Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Sample Selection\u003c/h2\u003e \u003cp\u003eIn this survey-based epidemiological study, subjects were enrolled using a random sampling method from the Jammu division of the north Indian population, from February 2021 to April 2022. The sampling process was done in two phases, wherein phase-I, using the approach of simple random sampling, subjects were enrolled from the Jammu population by face-face interview. Each participant was briefed about the research procedure and informed consent was obtained.\u003c/p\u003e \u003cp\u003eBut due to the COVID-19 pandemic and lockdown measures, we used E-based sampling via email with the aid of Google form (Phase II). Data collected from the E-based method was cleaned before merging with data collected from the face-to-face interview. All the incomplete data from the participants were excluded by our two authors (A.C.P \u0026amp; S.S).\u003c/p\u003e \u003cp\u003eThe inclusions of migraine patients from the representative participants were based on the criteria of the International Classification of Headache Disorders - ICHD-3. Questionnaires were designed according to the ICHD-3 to diagnose the headache and its types including migraine and tension-type headaches and their features among the Jammu population. The strategy or schematic concept for selecting the sample and use of ICHD-3 criteria is depicted in the \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Statistical analysis\u003c/h2\u003e \u003cp\u003eFor the descriptive data analysis of variables, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and frequency distribution were utilized for the continuous and discrete variables respectively. To find out the significant difference between the continuous variable and discrete variable, t-test and chi-square analysis were used. To establish the significant association between the environmental risk attribute and the headache, a logistic regression model using an Odds ratio (OR) with 95% confidence interval (CIs) and a p-value with \u0026lt;\u0026thinsp;0.05 was used. All the calculation was done using the free online statistical software including T-test calculator (graphpad.com), Chi-Square Calculator 2x2 (socscistatistics.com), and MedCalc's Odds ratio calculator. For the presentation of the association value/ OR value, \u0026ldquo;Edge weighted spring embedded layout\u0026rdquo; was used to draw the association, and Cytoscape: An Open-Source Platform for Complex Network Analysis and Visualization was utilized to draw the structure.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Result","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Demography characteristics\u003c/h2\u003e \u003cp\u003eA total of 3,148 subjects (24.87\u0026thinsp;\u0026plusmn;\u0026thinsp;10.32) representing the male 1223 (38.85%) and female 1925 (61.14%) with a mean age of 25.73\u0026thinsp;\u0026plusmn;\u0026thinsp;11.55 and 24.32\u0026thinsp;\u0026plusmn;\u0026thinsp;9.42 respectively were included. The difference between the mean age was found to be extremely statistically significant (p value\u0026thinsp;=\u0026thinsp;0.0002) and the observed difference was due to chance. The participants included were from different regions of the Jammu division, where many were seen from the Jammu district (37.26%), Kishtwar (17.24), Kathua (13.18%) Udhampur (10.10%) \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA\u003cb\u003e).\u003c/b\u003e Regarding the marital status of the participants, the majority were found un married (79.86%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB) and concerning the occupation status of the participants, the majority were found to be students with (77.22%) \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC\u003cb\u003e).\u003c/b\u003e It seems that the subjects mostly favor the mixed dietary pattern including the veg and non-vegetarian, but between veg and non-vegetarian many were found to prefer the non-vegetarian diet (27.98%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eD). Intake of water (measured in liters) was also observed where it was found that 31.16% of participants take 2liter of water per day and more than 5 liters only 3.04%. \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eE\u003cb\u003e).\u003c/b\u003e Other lifestyle factor estimates including smoking, alcohol, and physical activity were presented in \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eF\u003cb\u003e).\u003c/b\u003e The detailed demographic features and frequency distribution of the participants is presented in \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency distribution of demographic features\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003evariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrouping\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal (n) (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMale (n) (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFemale (n) (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSample size\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1925\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalculation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en/3148*100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en/1223*100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en/1925*100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 to 19 yrs.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1072 (34.05%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e448 (36.63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e624 (32.41%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 to 35 yrs.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1656 (52.60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e580 (47.42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1076 (55.89%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 to 55 yrs.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e337 (10.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e148 (12.10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e189 (9.81%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 to 75 yrs.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (2.66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47 (3.84%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37 (1.92%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e633 (20.10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e274 (22.40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e359 (18.64%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2514 (79.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e948 (77.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1566 (81.35%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorce\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.03%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.08%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2431 (77.22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e889 (72.69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1542 (80.10%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovt. Job\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e278 (8.83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e166 (13.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e112 (5.81%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePvt. Job\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e211 (6.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e156 (12.75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55 (2.85%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (0.38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (0.98%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHouse wife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e216 (6.86%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e216 (11.22%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eCommunity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHindu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2273(72.20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e799 (65.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1474 (76.57%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e809 (25.69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e405 (33.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e404 (20.98%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSikh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (1.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (1.55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42 (2.18%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBuddhist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (0.15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (0.25%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eWater intake\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e359 (11.40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87 (7.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e272 (14.12%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e649 (20.61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e218 (17.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e431 (22.38%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e981 (31.16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e397 (32.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e584 (30.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e623 (19.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e260 (21.25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e363 (18.85%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e273 (8.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e129 (10.54%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e144 (7.48%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e167 (5.30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83 (7.78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84 (4.36%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 l\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96 (3.04%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (4.006%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47 (2.44%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDiet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVeg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1608 (51.08%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e486 (33.73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1122 (58.28%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-veg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e881 (27.98%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e406 (33.19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e475 (24.67%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e659 (20.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e331 (27.06%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e328 (17.03%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCaffeine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2237 (71.06%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e855 (69.91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1382 (71.79%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDairy Product\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2547 (80.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e951 (77.75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1596 (82.90%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunk Food\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1546 (49.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e542 (44.31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1004 (52.15%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135 (4.28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e115 (9.40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20 (1.03%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN/A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e157 (4.98%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e135 (11.03%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (1.14%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Prevalence\u003c/h2\u003e \u003cp\u003eIn the present epidemiology study, the prevalence rate of headache was found near 53.84% with a mean age of 24.95\u0026thinsp;\u0026plusmn;\u0026thinsp;10.06. Representing the total prevalence of males with a mean age of 25.83\u0026thinsp;\u0026plusmn;\u0026thinsp;11.51, it was nearly 15.66% in compression to females (24.59\u0026thinsp;\u0026plusmn;\u0026thinsp;9.39) where the rate was high quite 38.18%.\u003c/p\u003e \u003cp\u003eAfter sub-grouping of the \u0026ldquo;headache diagnosed participants\u0026rdquo; based on the criteria \u0026ldquo;where did they belong to?\u0026rdquo;, the maximum prevalence was observed in the district of Jammu (41.23%) followed by the Kishtwar (16.99%), Kathua (11.44%), and Udhampur district (10.10%). The frequency distribution of headache prevalence is presented in the Jammu \u0026amp; Kashmir map \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWe also analyzed the different types of headaches, majorly the migraine \u0026ldquo;a neurovascular inflammatory disorder\u0026rdquo;, menstrual migraines/ hormonal headaches, and Tension-type Headache (TTH) (a stress-related headache). We observed that the prevalence of migraine was found 33.25% with males (24.45\u0026thinsp;\u0026plusmn;\u0026thinsp;10.76) representing the total prevalence of 7.97% and females (24.23\u0026thinsp;\u0026plusmn;\u0026thinsp;9) near 25.28%. Also, the \u0026ldquo;mensuration migraine\u0026rdquo; prevalence of 11.34%. Another headache type that we observed was TTH, where the total prevalence was found near 20.58% with males representing 12.89% and female was 7.68%.\u003c/p\u003e \u003cp\u003eGrouping headache subjects on the bases of the \u0026ldquo;age group\u0026rdquo;, it was observed that the highest prevalence was found in the age group of 20\u0026ndash;35 years (mean age: 23.79\u0026thinsp;\u0026plusmn;\u0026thinsp;4.03) (young adults) representing 55.28% with female dominance i.e., 75.77% (male:24.22%) \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. Migraine was found to be more prevalent (58.07%) in the same age group (20\u0026ndash;35 years) than TTH (50.77%). But in the middle-aged group (36\u0026ndash;55 years), the prevalence of TTH was slightly increased (13.27%) than migraine (9.83%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGrouping of headache subjects using different age groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHeadache (n\u0026thinsp;=\u0026thinsp;1695) (n) (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMigraine (n\u0026thinsp;=\u0026thinsp;1047) (n) (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTTH (n\u0026thinsp;=\u0026thinsp;648) (n) (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e10\u0026ndash;19 (Adolescent)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c3\" namest=\"c2\" rowspan=\"3\"\u003e \u003cp\u003e17.65\u0026thinsp;\u0026plusmn;\u0026thinsp;10.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e532 (31.38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e315 (30.08%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e217 (33.48%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e184 (34.58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e88 (27.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e96 (44.23%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e348 (65.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e227 (72.06%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e121 (55.76%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e20\u0026ndash;35 (YA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c3\" namest=\"c2\" rowspan=\"3\"\u003e \u003cp\u003e23.79\u0026thinsp;\u0026plusmn;\u0026thinsp;10.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e937 (55.28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e608 (58.07%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e329 (50.77%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e227 (24.22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e127 (20.88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100 (30.39%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e710 (75.77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e481 (79.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e229 (69.60%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e36\u0026ndash;55 (MAG)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c3\" namest=\"c2\" rowspan=\"3\"\u003e \u003cp\u003e44.16\u0026thinsp;\u0026plusmn;\u0026thinsp;10.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e189 (11.15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e103 (9.83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e86 (13.27%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65 (34.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26 (25.24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e39 (45.34%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e124 (65.60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e77 (74.75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e47 (54.65%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e56\u0026ndash;75 (OAA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c3\" namest=\"c2\" rowspan=\"3\"\u003e \u003cp\u003e61.21\u0026thinsp;\u0026plusmn;\u0026thinsp;10.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37 (2.18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21 (2.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16 (2.46%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (45.94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (47.61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7 (43.75%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20 (54.05%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (52.38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9 (56.25%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cb\u003eYA\u003c/b\u003e: Young Adults, \u003cb\u003eMAG\u003c/b\u003e: Middle Aged Group, \u003cb\u003eOAA\u003c/b\u003e: Old Age Group\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Association of environmental risk factors\u003c/h2\u003e \u003cp\u003eAs the study was not restricted to finding the condition prevalence, we also explored the different environmental risk attributes/lifestyle risk attribute which may contribute to the disease\u0026rsquo;s likelihood. A diverse range of factors was found to be associated with headache which significantly increases the chance of diseases (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStress, an inevitable factor contributes significantly to the likelihood of the diseases with an associated value of OR: 3.58, 95% CIs [3.07\u0026ndash;4.17] (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). After analyzing the different forms of stress, educational stress {OR: 3.41 [2.81\u0026ndash;4.12] (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001)} was found to be more effective than emotional OR: 3.02, 95% CIs [2.38\u0026ndash;3.83] (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), and physical stress which include the extreme household work, long working hours, etc. OR: 2.07, 95% CIs [1.42\u0026ndash;3.02] (p\u0026thinsp;=\u0026thinsp;0.0001). Proper sleep is considered a good indicator of a healthy life but a loss of sleep is a major contributor to the risk of various diseases. In this respect, we also found that sleep less significantly impacted the risk of headache (OR: 2.19, 95% CIs [1.83\u0026ndash;2.62] (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Stress causes significant loss of sleep with an association value OR: 2.28, 95% CIs [1.8784\u0026ndash;2.7854] (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e \u003cp\u003eWe have also observed that headache subjects were significantly associated with the low water intake, including\u0026thinsp;\u0026lt;\u0026thinsp;1 liter with an association ration of OR: 2.50, 95% CIs [1.97\u0026ndash;3.17] (p-value: \u0026lt;0.0001), 2 liter OR: 1.34, 95% CIs [1.13\u0026ndash;1.59] (p\u0026thinsp;=\u0026thinsp;0.007), and 3 liter OR: 1.1, 95% CIs [0.94\u0026ndash;1.49] (p\u0026thinsp;=\u0026thinsp;0.14). Regarding the dietary habit, red meat/ non-vegetarian food was not found to be associated with the risk of headache OR: 1.00, 95% CIs [0.85\u0026ndash;1.18] (p\u0026thinsp;=\u0026thinsp;0.9487), but on the other hand junk food, dairy products (such as milk, curd, ice-creams, etc.) and caffeine intake were found to be significantly associated with the condition with an OR: 1.95, 95% CIs [1.69\u0026ndash;2.25] (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), OR: 1.36, 95% CIs [1.14\u0026ndash;1.62] (p\u0026thinsp;=\u0026thinsp;0.0006) and OR: 0.80, 95% CIs [0.70\u0026ndash;0.91] (p\u0026thinsp;=\u0026thinsp;0.0015) respectively. Also, it was observed that an empty stomach increases the risk of the condition by 3.4% (OR: 3.42, 95% CIs [2.93\u0026ndash;3.98] (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e \u003cp\u003eChanges in the weather condition have also been found to increase the risk of headaches whereas the hot temperature was found to increase the risk by 2.3% (OR: 2.35, 95% CIs [1.88\u0026ndash;2.95] (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Bright light including bright sunlight, high beam light, flashing/ flickering of light, and sound (loud sound) was found a major risk factor for headache, increasing the risk by OR: 5.81, 95% CIs [4.96\u0026ndash;6.81] (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) and OR: 5.17, 95% CIs [4.44\u0026ndash;6.03] (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e \u003cp\u003eTo this end, a lot of environmental risk factors have been found which are presented in the frequency weighted association graph \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e to be significantly associated with the risk of headache. As we know, minimizing the interaction with the environmental risk factor can significantly minimize the risk of headache.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Comorbidity\u003c/h2\u003e \u003cp\u003eIn the present study we have also explored the comorbidities associated with headache. As a result, different diseases were found such as Hypo Thy (Hypothyroidism). OR: 2.5886, 95% CIs [1.0248\u0026ndash;6.5386] (p\u0026thinsp;=\u0026thinsp;0.0442), IBS (Irritable Bowel Syndrome) OR: 3.8084, 95% [1.7610\u0026ndash;8.2360] (p\u0026thinsp;=\u0026thinsp;0.0007), PCOS (Poly cystic Ovarian Syndrome) OR: 8.6336, 95% CIs [3.9528\u0026ndash;18.8570] (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), anxiety OR: 4.5373, 95% CIs [3.9000-5.2787] (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), hypertension (HT) OR: 2.9246, 95% CIs [1.9785\u0026ndash;4.3231] (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), depression OR: 1.9363, 95% CIs [1.1651\u0026ndash;3.2181] (p\u0026thinsp;=\u0026thinsp;0.0108), panic disorder (PD) OR: 5.0411, 95% CIs [1.9463\u0026ndash;3.0570] (p\u0026thinsp;=\u0026thinsp;0.0009), uric acid (UA) OR: 4.7390, 95% CIs [1.0487\u0026ndash;2.14158] (p\u0026thinsp;=\u0026thinsp;0.0432). All the comorbidity association presented in the ORs weighted comorbidity graph \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. Significant differences have been found with respect to their frequency in between headache and non-headache.\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Prevalence rate\u003c/h2\u003e \u003cp\u003eThe Global Burden of Disease (GBD)-2019 has revealed that headache prevalence is much higher in the top economically developed nations, with the greatest prevalence rates being observed in Italy (49.02%) and the USA (45.11%). Regarding the India\u0026rsquo;s neighbouring countries and the states of India, the highest prevalence has been recorded in Sri Lanka (37.2%) followed by Nepal (35.95) and the states of Sikkim (38.08%) and Goa (35.24%) respectively (\u003cb\u003eGlobal Burden of Disease (GBD)-2019\u003c/b\u003e).\u003c/p\u003e \u003cp\u003eIn the current study, high headache prevalence estimates were found (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) which is also consistent with the other epidemiological study conducted in different regions of India. In south India, headache prevalence is 63.9% with a female preponderance of 73% in comparison to male (54.4%), TTH is 34.8% and migraine 25.6% (female:32.4% \u0026amp; male: 18.6%) (Kulkarni et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). In the eastern states of India, headache prevalence was 14.87% where the females were 23.51% and males were 5.44 and migraine was 14.12% (males: 5.35% and 22.16%) (Ray et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). In the north Indian region, different studies have shown that the headache prevalence is 63.9% wherein females were found to be more affected (74.3%) as compared to males (32.6%). Prevalence of migraine was 13.44% with a female preponderance (87.5%) \u003cb\u003e(Nandha et al., 2013).\u003c/b\u003e A prospective observational study in the north Indian population found that 67.7% of patients had migraine and 32.2% of patients had tension-type headaches (TTH) \u003cb\u003e(\u003c/b\u003eSastry et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). In the valley of Kashmir, headache in the pediatric population was observed where the frequency was found at 66.4% with the female at 65.15% and male at 35.85%, Migraine at 26.98%, and TTH at 50.99% (Malik et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Another group found the headache frequency rate equal to 66.20% (19\u0026ndash;45 years) with female dominancy (61.82%) to male (38.18%). In migraine, the total prevalence was found 45.69% with 55.44% in females and 32.0% in males \u003cb\u003e(\u003c/b\u003eMasoodi et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo this end, the prevalence of headache and its type varies from region to region and this disparity is mighty due to the different sampling approach (simple random, clustered, stratified sampling), different sample size, type of study (population-based/ hospital case-control, cohort), the differing methodology adopted, differences in defining the criteria of headache prevalence (1 year vs. 3 months), coexisting environmental factors, urban/rural differences, or ethnicity of the studied population.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e4.2. Environmental risk factors\u003c/h2\u003e \u003cp\u003eHeadaches were strongly connected with concurrent disorders, routine drug use, analgesic use for diseases other than headaches, and a variety of environmental risk variables \u003cb\u003e(\u003c/b\u003eNieswand et al. \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). In the present study, different environmental factors have been observed which increase the risk of condition significantly \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eIn the present study, bright light was found significantly (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) associated with headache (OR: 5.81) and various studies have supported the fact that bright light within the range of 450 nm to 578 nm wavelength significantly alter the condition (Drummond, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e1986\u003c/span\u003e; Main et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Ofovwe \u0026amp; Ofili, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2010\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e Bright light significantly excites the nociceptive neurons in superficial laminae of trigeminal subnucleus caudalis (Vc/C1) mediated by an intraocular mechanism and transmission through the TRG (Trigeminal root ganglion) \u003cb\u003e(\u003c/b\u003eOkamoto et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) and responsible for pain \u003cb\u003e(\u003c/b\u003eMoulton et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Bright light also modulates the dura-sensitive neurons in the posterior thalamus whose axons are projected extensively across layers I\u0026ndash;V of somatosensory, visual, and associative cortices. The cell bodies and dendrites of such dura/light-sensitive neurons were opposed by axons originating from retinal ganglion cells (RGCs), predominantly from intrinsicality photosensitive RGCs (Retinal Ganglion Cells) \u003cb\u003e(\u003c/b\u003eNoseda et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Other than the classical pathways, a research study has also supported the other non-classical pathway mediated through the melanopsin, a photopigment that underlies subconscious vision, in the trigeminal nerve (Matynia et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). CGRP (Calcitonin Gene Related Peptide), a potent vasodilator has been found to mediate the transfer of bright light stimulus and anti-CGRP or vasoconstrictive agents blocked light-evoked neural activity (Okamoto et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Navratilova et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWeather is another interesting risk factor that have been found to be a profound risk attribute of headaches, as we have also observed that different weather conditions significantly increase the likelihood of headaches (\u003cb\u003eSee\u003c/b\u003e \u003cspan refid=\"Sec5\" class=\"InternalRef\"\u003e\u003cb\u003eResult\u003c/b\u003e\u003c/span\u003e \u003cb\u003esection\u003c/b\u003e). In support of our study, other studies have shown that weather changes act as a trigger for headache onset or the worsening of ongoing headache symptoms (Prince et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). Lower temperature and higher relative humidity have been significantly associated with the onset of a migraine period (Hoffmann et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Increases and decreases in temperature lead to a significant increase in the number of migraine attacks \u003cb\u003e(\u003c/b\u003eScheidt et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Temperature change accounted for 16.5% of the variance in headache incidence in winter and 9.6% in summer \u003cb\u003e(\u003c/b\u003eYang et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). This high variance is due to the variance for the temperature and sunshine duration, followed by humidity and pressure during cold \u003cb\u003e(\u003c/b\u003eYang et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eTRPM8\u003c/em\u003e (Transient receptor-potential M8), a cation channel (Na\u003csup\u003e+\u003c/sup\u003e and Ca\u003csup\u003e++\u003c/sup\u003e) is the prime candidate for temperature sensation and is expressed in pain sensory neurons \u003cb\u003e(\u003c/b\u003eMcKemy et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) Genome-wide association studies (GWAS) have implicated the TRPM8 channel in association migraine \u003cb\u003e(\u003c/b\u003eHautakangas et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) and it has been found that decreased expression of \u003cem\u003eTRPM8\u003c/em\u003e is associated with a reduced risk for migraine where homozygous carriers of rs10166942[C] were less sensitive to cold pain \u003cb\u003e(\u003c/b\u003eMcKemy et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2002\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStress can be physiological and oxidative wherein physiological stress includes social support, loneliness, marriage status, social disruption, work environment, social status, social integration, etc, and oxidative represents the increased reactive oxygen species and reactive nitrogen species in the blood. Other than oxidative, physiological stress has greatly influenced the headache where it is found that an increase in the stress intensity will increase the headache frequency (Schramm et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Different forms include occupational stress (Lin et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; \u003cb\u003eGillespie et al., 2015;\u003c/b\u003e Godwin et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), educational stress (Ghorbani et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Ibrahim et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) have been found to be associated with headaches.\u003c/p\u003e \u003cp\u003eSleep quality is closely linked to headache (\u003cb\u003eYokoyama et al., 2019\u003c/b\u003e), which affects around 30\u0026ndash;50% of migraine patients, and is one of the reasons why migraine sufferers are prone to morning headaches because of sleep deprivation. The impact of sleep disturbances increases self-reported pain and leads to a disturbance of the descending pain inhibitory control system \u003cb\u003e(\u003c/b\u003eLin et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Negro et al \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnother important risk factor that was found to be significantly associated with the condition was less water intake (\u003cb\u003eSee\u003c/b\u003e \u003cspan refid=\"Sec5\" class=\"InternalRef\"\u003e\u003cb\u003eResult\u003c/b\u003e\u003c/span\u003e \u003cb\u003eSection\u003c/b\u003e). In support of our study, various studies have found that water deprivation may play a role in migraine, particularly in prolonging attacks \u003cb\u003e(\u003c/b\u003eBlau et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2004\u003c/span\u003e), and drinking more water resulted in a statistically significant improvement (Price \u0026amp; Burls, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). This water ingestion provided relief from headache within 30min to 3hr. It is proposed that water deprivation-induced headache is the result of intracranial dehydration and total plasma volume (Popkin et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). Studies have also shown that water intake did not affect the number of headache episodes, but was associated modestly with a reduction in headache intensity and reduced duration of headache \u003cb\u003e(\u003c/b\u003eSpigt et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). Despite such benefits of water intake, it has also been shown that headache is also caused by drinking cold water which is called \u0026ldquo;ice-water stimulus provoked headache\u0026rdquo; attributed to ingestion or inhalation of a cold stimulus (Mages et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) and this pain perception is induced by a cold palatal stimulus \u003cb\u003e(\u003c/b\u003eMattsson, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; Mages et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). There has been also reported that there has a negative correlation between water intake and the frequency of headaches. (Khorsha et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe most extensively used psychostimulant substance in the world is caffeine, also known as trimethylxanthine, an alkaloid that occurs naturally in several plants. The current study provides insight into the risk-attribution potential of caffeine by demonstrating its modest risk capability which significantly (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) increases the chance of condition by 1.95fold. In support of our study, population-based cases and controls have found that patients with chronic daily headache (CDH) were more likely overall to have been high caffeine consumers before the onset of CDH \u003cb\u003e(\u003c/b\u003eScher et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). Also, a prospective cohort study, conducted by Mostofsky and the group found that high levels of caffeinated beverage intake may be a trigger of migraine headaches \u003cb\u003e(\u003c/b\u003eMostofsky et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). It has also been shown that the sudden cessation of caffeine use after chronic exposures leads to a withdrawal syndrome with headache as a dominant symptom \u003cb\u003e(\u003c/b\u003eShapiro, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2008\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e, constipation, impaired behavioural and cognitive performance, joint pains, decreased or increased blood pressure, increased heart rate, hand tremor, increased diuresis, and abdominal pain \u003cb\u003e(\u003c/b\u003eJuliano \u0026amp; Griffiths, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; \u003cb\u003eMeredith et al., 2013).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eBut in contrast to its risk attribution, with intermittent exposure, caffeine may act as a mild analgesic for headache or as an adjuvant for the actions of other analgesics (Shapiro, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). The doses of 130 mg enhance the efficacy of analgesics in TTH and doses of \u0026ge;\u0026thinsp;100 mg enhance benefits in migraine \u003cb\u003e(\u003c/b\u003eLipton et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). It is not recommended to exceed 400\u0026ndash;450 mg/day, because chronic repetitive exposures to caffeine increase the risks for the development of analgesic-overuse headache, and chronic daily headache (Hering-Hanit \u0026amp; Gadoth, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). Caffeine is rapidly and completely absorbed into the bloodstream after oral ingestion, with peak blood levels reached in 30 min to 45 min. Caffeine with a typical half-life of four to six hours is metabolized by the liver and is excreted by the kidneys via urine \u003cb\u003e(Meredith et al.2013)\u003c/b\u003e. Caffeine molecules are structurally similar to adenosine and bind to adenosine receptors on the cell surface and act as competitive inhibitors. As the inhibitory effect of caffeine on adenosine receptors, the state of cortical hyperexcitability is established and this increases alertness and improves cognitive function \u003cb\u003e(\u003c/b\u003eEspinosa Jovel \u0026amp; Sobrino Mej\u0026iacute;a, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2017\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e Also, caffeine releases dopamine and stimulates glucose utilization in the prefrontal cortex and a caudate nucleus respectively which help in positive reinforcement and mediates motor activity and regulate the sleep-wake cycle respectively \u003cb\u003e(\u003c/b\u003eO'Callaghan et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWe also observed that empty stomach/ fasting significantly (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) increases the likelihood of headache by 3.42fold, which is also supported by various epidemiological studies (B\u0026aacute;nk \u0026amp; M\u0026aacute;rton, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e2000\u003c/span\u003e; Abu-Salameh et al., \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). The length of the fasting-induced headache is dependent on the length of the fast and pain is featured as non-pulsating, mild to moderately intense, wide, or centred in the frontal area (Torelli \u0026amp; Manzoni, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). The fact has also been supported that after a long time if an individual takes a meal, the chance of postprandial fasting-related headaches increases which is featured with episodic in nature, heaviness (AlAmri et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). The proposed mechanism depicts that a network of neurons and astrocytes may collectively depolarize as a result of an imbalance between the excitatory and inhibitory processes set by a lack of glycogen-derived glucose at the start of intensive synaptic activity. Activating pannexin1 channels in neurons and starting parenchymal inflammatory pathways, may stimulate perivascular trigeminal afferents \u003cb\u003e(Dalkara \u0026amp; Kilic, 2013).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eIn addition, dietary habit such as consumption of red meat/ non-vegetarian food was not found significantly ((p\u0026thinsp;=\u0026thinsp;0.9487) associated with headache but on the other hand junk food, dairy products (such as milk, curd, ice-creams, etc.) significantly associated with the condition with an OR: 1.95, 95% CIs [1.69\u0026ndash;2.25] (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), OR: 1.36, 95% CIs [1.14\u0026ndash;1.62] (p\u0026thinsp;=\u0026thinsp;0.0006). Regarding diary products conflicting result have been reported (Mansouri et al., \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and patients with migraines consumed less milk than people without migraines (Nazari \u0026amp; Eghbali, \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Rist et al., \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEnclosing the section, the present epidemiology study has presented a various range of environmental risk attributes that significantly increases the likelihood of headache. Patients with headaches need to be enlightened about the risk factors that contribute to their condition so that they can avoid them and possibly reduce their headache frequency.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e4.3. Comorbidities\u003c/h2\u003e \u003cp\u003eCo-morbidity is another great thing of concern that needs to be thought about and is defined as the presence of two or more chronic conditions at the same time \u003cb\u003e(\u003c/b\u003eValderas et al., \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Comorbidity with headache is a common concern, with more than a third of patients seen by primary care physicians having four or more chronic health issues, and a small percentage having more than ten.\u003c/p\u003e \u003cp\u003eIn the present epidemiological study, various condition has been found to be associated with headache \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. As in the present study, IBS was found to be highly associated with headache {OR: 3.8084, 95% [1.7610\u0026ndash;8.2360] (p\u0026thinsp;=\u0026thinsp;0.0007)}. Different epidemiological research from different parts of the world has shown the high rates of co-existing IBS and headache which supports our research \u003cb\u003e(\u003c/b\u003eChang \u0026amp; Lu, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Lau et al., \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; \u003cb\u003eMirzaei et al.,2016;\u003c/b\u003e Li et al., \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Kawashima et al., \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Grover et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Headache sufferers specifically migraineurs with long headache history and high headache frequency have a higher chance of being diagnosed with IBS. IBS and migraine share some similarities and can alter gut microflora composition and thereby may affect the gut-brain axis and inflammatory status \u003cb\u003e(\u003c/b\u003eArzani et al., \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). A key neurotransmitter i.e., serotonin plays a role in both conditions, wherein IBS serotonin causes excessive bowel motions, a lot of digestive output, as well as visceral hypersensitivity in the gut, and defective serotonin activity in the central nervous system is responsible for the migraine. \u003cb\u003e(\u003c/b\u003eCamilleri, \u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e2009\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e In addition, individuals with IBS and migraine have been found to have high family aggregation and genetic variations, such as those in the serotonin reuptake transporter gene (5-HTTLPR) \u003cb\u003e(\u003c/b\u003eSch\u0026uuml;rks et al., \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Zhang et al., \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOther than IBS, PCOS was also found to be significantly (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) associated with headache (OR: 8.6336). Different studies have shown that women with PCOS are burdened with multimorbidity which includes hypertension, tendinitis, osteoarthritis, fractures, endometriosis, and importantly migraine \u003cb\u003e(\u003c/b\u003eGlintborg et al., \u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; \u003cb\u003eBanday et al., 2022\u003c/b\u003e Kujanp\u0026auml;\u0026auml; et al., \u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). The PCOS-disease subnetworks were subjected to pathway enrichment analysis and found a substantial relationship between PCOS and other illnesses like hypertension and migraine \u003cb\u003e(\u003c/b\u003eRamly et al., \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Other conditions like \u003cb\u003ea\u003c/b\u003enxiety, hypertension, depression, and panic disorder are also comorbid conditions associated with the headache (Muayqil et al., \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Caponnetto et al., \u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Togha et al., \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) including uric acid and \u003cb\u003e(\u003c/b\u003eYazar et al., \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and hypothyroidism (\u003cb\u003eLima et al., 2017;\u003c/b\u003e Rubino et al., \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Spanou et al., \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Increased levels of uric acid and serum cholesterol have been reported to strongly correlate with white matter hyperintensities; this association may be explained by altered endothelial dysfunction and increased attack frequency \u003cb\u003e(\u003c/b\u003eTrauninger et al., \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eComorbidity of diseases with headaches may be due to several reasons some of which include sharing common pathophysiological mechanisms (\u003cb\u003eLauritzen et al., 2011)\u003c/b\u003e, common risk factors including the common genetic variants, and common environmental risk factors. Comorbidity with common diseases is mostly concerned with the sharing of common risk attributes which are frequently used whether it is genetic or environmental factors.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eHeadache affects millions of individuals across the country and is defined as a complicated neurovascular condition, not merely a simple discomfort. Many different diseases are linked with headaches and a diverse range of environmental, lifestyle and genetics factors have been observed. Therefore, limiting the exposure to environmental factors could decrease the likelihood of occurrence of headache. Hence, the headache is found to be a highly prevalent neurovascular condition among the people of Jammu division of the north Indian population.\u003c/p\u003e"},{"header":"List Of Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eTTH\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTension-type headache\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eGBD\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGlobal burden Disorder\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eUT\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUnion Terr\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eICHD-3\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Classification of Headache Disorder-3\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eOR\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCIs\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eIBS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIrritable Bowel Syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003ePCOS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePolycystic Ovarian Syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eUSA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUnited States of America\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eTRG\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTrigeminal root ganglion\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eRGCs\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRetinal Ganglion Cells\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCGRP\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCalcitonin Gene-Related Peptide\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eTRPM8\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTransient receptor-potential M8\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eGWAS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGenome-Wide Association study\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eStatement of Ethics: \u0026nbsp;\u0026nbsp;\u003c/strong\u003eThe present study\u0026nbsp;design was duly approved by the Institutional Ethical Committee (IEC), University\u0026nbsp;of Jammu vide notification number\u0026nbsp;EC: DRS/22/4969) and Institutional Ethics Committee, Government Medical College, Jammu (ECR/454/Inst/JK/2013/RR-20). \u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003eData was done after having informed written consent from each study\u0026nbsp;participant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e The data from the current study is unavailable to the public due to restrictions. Interested researchers should contact \u003cstrong\u003eDr. Parvinder Kumar\u003c/strong\u003e ([email protected]) who oversaw the data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest Statement:\u003c/strong\u003e The authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Sources:\u003c/strong\u003e This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e \u003cstrong\u003eDr.\u003c/strong\u003e \u003cstrong\u003eParvinder Kumar\u003c/strong\u003e \u003cstrong\u003e\u0026amp; Amrit Sudershan\u0026nbsp;\u003c/strong\u003econtribute to the study design, \u003cstrong\u003eAmrit Sudershan, Dr. Mohd. Younis, Agar Chander Pushap \u0026amp; Srishty Sudershan\u003c/strong\u003e Conducted the survey, \u003cstrong\u003eAgar Chander Pushap \u0026amp; Srishty Sudershan\u003c/strong\u003e helped with data cleaning, \u003cstrong\u003eAgar Chander Pushap \u0026amp; Amrit Sudershan\u003c/strong\u003e analysed the data. \u003cstrong\u003eAmrit Sudershan \u0026amp; Dr. Mohd Younis\u0026nbsp;\u003c/strong\u003edrafted the manuscript and edited the pictures and table. \u003cstrong\u003eDr. Parvinder Kumar \u0026amp; Dr. Mohd. Younis\u003c/strong\u003e edited the manuscript\u003cstrong\u003e, Dr.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eParvinder Kumar\u003c/strong\u003e finalize the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment: \u0026nbsp;\u003c/strong\u003eAuthors are thankful to the Institute of Human Genetics, University of Jammu,\u0026nbsp;\u003cstrong\u003eDr. Pragya Khanna\u003c/strong\u003e (Principal at GLDM Degree College Hiranagar, Jammu, Jammu \u0026amp; Kashmir-UT),\u0026nbsp;\u003cstrong\u003eDr. Roopali Fotra\u003c/strong\u003e (Department of Zoology),\u0026nbsp;\u003cstrong\u003eDr. Sanjay Bhagat\u003c/strong\u003e (Indira Gandhi Govt. \u003cem\u003eDental College, Jammu, Jammu \u0026amp; Kashmir-UT),\u0026nbsp;\u003c/em\u003e\u003cem\u003e\u003cstrong\u003eShikha Sharma\u003c/strong\u003e (Research scholar at Department of Zoology, Lovely Professional University, Phagwara, Punjab) for their valuable support during the sampling period.\u003c/em\u003e\u003cem\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSteiner, T. J., Stovner, L. J., Jensen, R., Uluduz, D., Katsarava, Z., \u0026amp; Lifting The Burden: the Global Campaign against Headache (2020). Migraine remains second among the world's causes of disability, and first among young women: findings from GBD2019. The journal of headache and pain, \u003cem\u003e21\u003c/em\u003e(1), 137. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s10194-020-01208-0\u003c/span\u003e\u003cspan address=\"10.1186/s10194-020-01208-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGBD 2019 Diseases and Injuries Collaborators (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u0026ndash;2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet (London, England), \u003cem\u003e396\u003c/em\u003e(10258), 1204\u0026ndash;1222. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0140-6736(20)30925-9\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(20)30925-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilkes, M.J., Mendis, M.D., Bisset, L., Leung, F. T., Sexton, C. T., \u0026amp; Hides, J. A. (2021). The prevalence and burden of recurrent headache in Australian adolescents: findings from the longitudinal study of Australian children. The Journal of Headache and Pain, 22(49), 1\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s10194-021-01262-2\u003c/span\u003e\u003cspan address=\"10.1186/s10194-021-01262-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuvsannorov, O., Anisbayar, T., Davaasuren, M., Baatar, O., Batmagnai, K., Tumurbaatar, K., Enkhbaatar, S., Uluduz, D., Sasmaz, T., Solmaz, E. T., \u0026amp; Steiner, T. J. (2020). The prevalence of headache disorders in children and adolescents in Mongolia: a nationwide schools-based study. The Journal of Headache and Pain, 21(107), 1\u0026ndash;9 \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s10194-020-01175-6\u003c/span\u003e\u003cspan address=\"10.1186/s10194-020-01175-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIgarashi, H., Ueda, K., Jung, S., Cai, Z., Chen, Y., \u0026amp; Nakamura, T. (2020). Social burden of people with the migraine diagnosis in Japan: evidence from a population-based cross-sectional survey. BMJ open, 10(11), e038987. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/bmjopen-2020-038987\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2020-038987\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWong, L. P., Alias, H., Bhoo-Pathy, N., Chung, I., Chong, Y. C., Kalra, S., \u0026amp; Shah, Z. (2020). Impact of migraine on workplace productivity and monetary loss: a study of employees in banking sector in Malaysia. The journal of headache and pain, 21(1), 68. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s10194-020-01144-z\u003c/span\u003e\u003cspan address=\"10.1186/s10194-020-01144-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuse, D. C., Yugrakh, M. S., Lee, L. K., Bell, J., Cohen, J. M., \u0026amp; Lipton, R. B. (2020). Burden of Illness Among People with Migraine and \u0026ge; 4 Monthly Headache Days While Using Acute and/or Preventive Prescription Medications for Migraine. Journal of managed care \u0026amp; specialty pharmacy, 26(10), 1334\u0026ndash;1343. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.18553/jmcp.2020.20100\u003c/span\u003e\u003cspan address=\"10.18553/jmcp.2020.20100\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKulkarni, G. B., Rao, G. N., Gururaj, G., Stovner, L. J., \u0026amp; Steiner, T. J. (2015). Headache disorders and public ill-health in India: prevalence estimates in Karnataka State. The journal of headache and pain, 16, 67. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s10194-015-0549-x\u003c/span\u003e\u003cspan address=\"10.1186/s10194-015-0549-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRay, B. K., Paul, N., Hazra, A., Das, S., Ghosal, M. K., Misra, A. K., Banerjee, T. K., Chaudhuri, A., \u0026amp; Das, S. K. (2017). Prevalence, burden, and risk factors of migraine: A community-based study from Eastern India. Neurology India, 65(6), 1280\u0026ndash;1288. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/0028-3886.217979\u003c/span\u003e\u003cspan address=\"10.4103/0028-3886.217979\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalik, A. H., Shah, P. A., \u0026amp; Yaseen, Y. (2012). Prevalence of primary headache disorders in school-going children in Kashmir Valley (North-west India). Annals of Indian Academy of Neurology, 15(Suppl 1), S100\u0026ndash;S103. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/0972-2327.100030\u003c/span\u003e\u003cspan address=\"10.4103/0972-2327.100030\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMasoodi, Z. A., Shah, P. A., \u0026amp; Iqbal, I. (2016). Prevalence of headache in Kashmir Valley, India. Neurology Asia, 21(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNandha, R., \u0026amp; Chhabra, M. K. (2013). Prevalence and clinical characteristics of headache in dental students of a tertiary care teaching dental hospital in Northern India. Int J Basic Clin Pharmacol, 2(1), 51\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSastry, A. S., Kumar, A., Pathak, A., Chaurasia, R. N., Singh, V. K., Joshi, D., Singh, V., \u0026amp; Mishra, V. N. (2022). The pattern of primary headache in the North India population: a hospital-based study. The International journal of neuroscience, 1\u0026ndash;9. Advance online publication. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/00207454.2022.2075359\u003c/span\u003e\u003cspan address=\"10.1080/00207454.2022.2075359\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNieswand, V., Richter, M., Berner, R., von der Hagen, M., Klimova, A., Roeder, I., Koch, T., Sabatowski, R., \u0026amp; Gossrau, G. (2019). The prevalence of headache in German pupils of different ages and school types. Cephalalgia, 39(8), 1030\u0026ndash;1040. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0333102419837156\u003c/span\u003e\u003cspan address=\"10.1177/0333102419837156\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDrummond, P. D. (1986). A quantitative assessment of photophobia in migraine and tension headache. Headache: The Journal of Head and Face Pain, 26(9), 465\u0026ndash;469.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMain, A., Vlachonikolis, I., \u0026amp; Dowson, A. (2000). The wavelength of light causing photophobia in migraine and tension-type headache between attacks. Headache: The Journal of Head and Face Pain, 40(3), 194\u0026ndash;199.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOfovwe, G. E., \u0026amp; Ofili, A. N. (2010). Prevalence and impact of headache and migraine among secondary school students in Nigeria. Headache: The Journal of Head and Face Pain, 50(10), 1570\u0026ndash;1575.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkamoto, K., Tashiro, A., Chang, Z., \u0026amp; Bereiter, D. A. (2010). Bright light activates a trigeminal nociceptive pathway. PAIN\u0026reg;, 149(2), 235\u0026ndash;242.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoulton, E. A., Becerra, L., \u0026amp; Borsook, D. (2009). An fMRI case report of photophobia: activation of the trigeminal nociceptive pathway. Pain, 145(3), 358\u0026ndash;363.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNoseda, R., Kainz, V., Jakubowski, M., Gooley, J. J., Saper, C. B., Digre, K., \u0026amp; Burstein, R. (2010). A neural mechanism for exacerbation of headache by light. Nature neuroscience, 13(2), 239\u0026ndash;245. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/nn.2475\u003c/span\u003e\u003cspan address=\"10.1038/nn.2475\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatynia, A., Nguyen, E., Sun, X., Blixt, F. W., Parikh, S., Kessler, J., \u0026hellip; Gorin, M. B. (2016). Peripheral sensory neurons expressing melanopsin respond to light. Frontiers in Neural Circuits, 10, 60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNavratilova, E., Rau, J., Oyarzo, J., Tien, J., Mackenzie, K., Stratton, J., \u0026hellip; Porreca, F. (2019). CGRP-dependent and independent mechanisms of acute and persistent post-traumatic headache following mild traumatic brain injury in mice. Cephalalgia, 39(14), 1762\u0026ndash;1775.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrince, P. B., Rapoport, A. M., Sheftell, F. D., Tepper, S. J., \u0026amp; Bigal, M. E. (2004). The effect of weather on headache. Headache: The Journal of Head and Face Pain, 44(6), 596\u0026ndash;602.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoffmann, J., Lo, H., Neeb, L., Martus, P., \u0026amp; Reuter, U. (2011). Weather sensitivity in migraineurs. Journal of neurology, 258(4), 596\u0026ndash;602.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScheidt, J., Koppe, C., Rill, S., Reinel, D., Wogenstein, F., \u0026amp; Drescher, J. (2013). Influence of temperature changes on migraine occurrence in Germany. International journal of biometeorology, 57(4), 649\u0026ndash;654.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang, A. C., Fuh, J. L., Huang, N. E., Shia, B. C., \u0026amp; Wang, S. J. (2015). Patients with migraine are right about their perception of temperature as a trigger: time series analysis of headache diary data. The journal of headache and pain, 16(1), 1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang, A. C., Fuh, J. L., Huang, N. E., Shia, B. C., Peng, C. K., \u0026amp; Wang, S. J. (2011). Temporal associations between weather and headache: analysis by empirical mode decomposition. PloS one, 6(1), e14612.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcKemy, D. D., Neuhausser, W. M., \u0026amp; Julius, D. (2002). Identification of a cold receptor reveals a general role for TRP channels in thermosensation. Nature, 416(6876), 52\u0026ndash;58. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/nature719\u003c/span\u003e\u003cspan address=\"10.1038/nature719\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDussor, G., \u0026amp; Cao, Y. Q. (2016). TRPM8 and migraine. Headache: The Journal of Head and Face Pain, 56(9), 1406\u0026ndash;1417.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHautakangas, H., Winsvold, B. S., Ruotsalainen, S. E., Bjornsdottir, G., Harder, A., Kogelman, L., Thomas, L. F., Noordam, R., Benner, C., Gormley, P., Artto, V., Banasik, K., Bjornsdottir, A., Boomsma, D. I., Brumpton, B. M., Burgdorf, K. S., Buring, J. E., Chalmer, M. A., de Boer, I., Dichgans, M., \u0026hellip; Pirinen, M. (2022). Genome-wide analysis of 102,084 migraine cases identifies 123 risk loci and subtype-specific risk alleles. Nature genetics, 54(2), 152\u0026ndash;160. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41588-021-00990-0\u003c/span\u003e\u003cspan address=\"10.1038/s41588-021-00990-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchramm, S. H., Moebus, S., Lehmann, N., Galli, U., Obermann, M., Bock, E., Yoon, M. S., Diener, H. C., \u0026amp; Katsarava, Z. (2015). The association between stress and headache: A longitudinal population-based study. \u003cem\u003eCephalalgia: an international journal of headache\u003c/em\u003e, \u003cem\u003e35\u003c/em\u003e(10), 853\u0026ndash;863. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0333102414563087\u003c/span\u003e\u003cspan address=\"10.1177/0333102414563087\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin, K. C., Huang, C. C., \u0026amp; Wu, C. C. (2007). Association between stress at work and primary headache among nursing staff in Taiwan. \u003cem\u003eHeadache\u003c/em\u003e, \u003cem\u003e47\u003c/em\u003e(4), 576\u0026ndash;584. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1526-4610.2007.00759.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1526-4610.2007.00759.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGillespie, N. A., Walsh, M. H. W. A., Winefield, A. H., Dua, J., \u0026amp; Stough, C. (2001). Occupational stress in universities: Staff perceptions of the causes, consequences and moderators of stress. \u003cem\u003eWork\u003c/em\u003e \u0026amp; \u003cem\u003estress\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e(1), 53\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGodwin, A., Alex, L., \u0026amp; Selorm, F. H. (2016). Occupational stress and its management among nurses at St. Dominic Hospital, Akwatia, Ghana. \u003cem\u003eHealth Science Journal\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e(6), 0\u0026ndash;0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhorbani, A., Abtahi, S. M., Fereidan-Esfahani, M., Abtahi, S. H., Shemshaki, H., Akbari, M., \u0026amp; Mehrabi-Koushki, A. (2013). Prevalence and clinical characteristics of headache among medical students, Isfahan, Iran. \u003cem\u003eJournal of research in medical sciences: the official journal of Isfahan University of Medical Sciences\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(Suppl 1), S24\u0026ndash;S27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIbrahim, N. K., Alotaibi, A. K., Alhazmi, A. M., Alshehri, R. Z., Saimaldaher, R. N., \u0026amp; Murad, M. A. (2017). Prevalence, predictors and triggers of migraine headache among medical students and interns in King Abdulaziz University, Jeddah, Saudi Arabia. \u003cem\u003ePakistan journal of medical sciences\u003c/em\u003e, \u003cem\u003e33\u003c/em\u003e(2), 270\u0026ndash;275. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.12669/pjms.332.12139\u003c/span\u003e\u003cspan address=\"10.12669/pjms.332.12139\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYokoyama, M., Yokoyama, T., Funazu, K., Yamashita, T., Kondo, S., Hosoai, H., Yokoyama, A., \u0026amp; Nakamura, H. (2009). Associations between headache and stress, alcohol drinking, exercise, sleep, and comorbid health conditions in a Japanese population. The journal of headache and pain, \u003cem\u003e10\u003c/em\u003e(3), 177\u0026ndash;185. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10194-009-0113-7\u003c/span\u003e\u003cspan address=\"10.1007/s10194-009-0113-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin, Y.-K., Lin, G.-Y., Lee, J.-T., Lee, M.-S., Tsai, C.-K., Hsu, Y.-W., Lin, Y.-Z., Tsai, Y.-C., \u0026amp; Yang, F.-C. (2016). Associations Between Sleep Quality and Migraine Frequency: A Cross-Sectional Case-Control Study. Medicine, \u003cem\u003e95\u003c/em\u003e(17).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNegro, A., Seidel, J. L., Houben, T., Yu, E. S., Rosen, I., Arreguin, A. J., Yalcin, N., Shorser-Gentile, L., Pearlman, L., Sadhegian, H., Vetrivelan, R., Chamberlin, N. L., Ayata, C., Martelletti, P., Moskowitz, M. A., \u0026amp; Eikermann-Haerter, K. (2020). Acute sleep deprivation enhances susceptibility to the migraine substrate cortical spreading depolarization. The Journal of Headache and Pain 2020 21:1, 21(1), 1\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/S10194-020-01155-W\u003c/span\u003e\u003cspan address=\"10.1186/S10194-020-01155-W\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlau, J. N., Kell, C. A., \u0026amp; Sperling, J. M. (2004). Water-deprivation headache: a new headache with two variants. Headache, 44(1), 79\u0026ndash;83. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1526-4610.2004.04014.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1526-4610.2004.04014.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrice, A., \u0026amp; Burls, A. (2015). Increased water intake to reduce headache: learning from a critical appraisal. Journal of evaluation in clinical practice, 21(6), 1212\u0026ndash;1218.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePopkin, B. M., D'Anci, K. E., \u0026amp; Rosenberg, I. H. (2010). Water, hydration, and health. Nutrition reviews, 68(8), 439\u0026ndash;458.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpigt, M. G., Kuijper, E. C., Schayck, C. P., Troost, J., Knipschild, P. G., Linssen, V. M., \u0026amp; Knottnerus, J. A. (2005). Increasing the daily water intake for the prophylactic treatment of headache: a pilot trial. European journal of neurology, 12(9), 715\u0026ndash;718. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1468-1331.2005.01081.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1468-1331.2005.01081.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMages, S., Hensel, O., Zierz, A. M., Kraya, T., \u0026amp; Zierz, S. (2017). Experimental provocation of 'ice-cream headache' by ice cubes and ice water. Cephalalgia: an international journal of headache, 37(5), 464\u0026ndash;469. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0333102416650704\u003c/span\u003e\u003cspan address=\"10.1177/0333102416650704\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMattsson P. (2001). Headache caused by drinking cold water is common and related to active migraine. Cephalalgia: an international journal of headache, 21(3), 230\u0026ndash;235. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1046/j.1468-2982.2001.00211.x\u003c/span\u003e\u003cspan address=\"10.1046/j.1468-2982.2001.00211.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhorsha, F., Mirzababaei, A., Togha, M., \u0026amp; Mirzaei, K. (2020). Association of drinking water and migraine headache severity. Journal of clinical neuroscience: official journal of the Neurosurgical Society of Australasia, 77, 81\u0026ndash;84. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jocn.2020.05.034\u003c/span\u003e\u003cspan address=\"10.1016/j.jocn.2020.05.034\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScher, A. I., Stewart, W. F., \u0026amp; Lipton, R. B. (2004). Caffeine as a risk factor for chronic daily headache: a population-based study. Neurology, 63(11), 2022\u0026ndash;2027. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1212/01.wnl.0000145760.37852.ed\u003c/span\u003e\u003cspan address=\"10.1212/01.wnl.0000145760.37852.ed\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMostofsky, E., Mittleman, M. A., Buettner, C., Li, W., \u0026amp; Bertisch, S. M. (2019). Prospective Cohort Study of Caffeinated Beverage Intake as a Potential Trigger of Headaches among Migraineurs. The American journal of medicine, 132(8), 984\u0026ndash;991. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.amjmed.2019.02.015\u003c/span\u003e\u003cspan address=\"10.1016/j.amjmed.2019.02.015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJuliano, L. M., \u0026amp; Griffiths, R. R. (2004). A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features. \u003cem\u003ePsychopharmacology\u003c/em\u003e, \u003cem\u003e176\u003c/em\u003e(1), 1\u0026ndash;29. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00213-004-2000-x\u003c/span\u003e\u003cspan address=\"10.1007/s00213-004-2000-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJuliano, L. M., \u0026amp; Griffiths, R. R. (2004). A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features. \u003cem\u003ePsychopharmacology\u003c/em\u003e, \u003cem\u003e176\u003c/em\u003e(1), 1\u0026ndash;29. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00213-004-2000-x\u003c/span\u003e\u003cspan address=\"10.1007/s00213-004-2000-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShapiro, R. E. (2008). Caffeine and headaches. Current pain and headache reports, 12(4), 311\u0026ndash;315.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLipton, R. B., Diener, H. C., Robbins, M. S., Garas, S. Y., \u0026amp; Patel, K. (2017). Caffeine in the management of patients with headache. The journal of headache and pain, 18(1), 107. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s10194-017-0806-2\u003c/span\u003e\u003cspan address=\"10.1186/s10194-017-0806-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHering-Hanit, R., \u0026amp; Gadoth, N. (2003). Caffeine-induced headache in children and adolescents. Cephalalgia: an international journal of headache, 23(5), 332\u0026ndash;335. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1046/j.1468-2982.2003.00576.x\u003c/span\u003e\u003cspan address=\"10.1046/j.1468-2982.2003.00576.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEspinosa Jovel, C. A., \u0026amp; Sobrino Mej\u0026iacute;a, F. E. (2017). Caffeine and headache: specific remarks. Cafe\u0026iacute;na y cefalea: consideraciones especiales. Neurologia (Barcelona, Spain), 32(6), 394\u0026ndash;398. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.nrl.2014.12.016\u003c/span\u003e\u003cspan address=\"10.1016/j.nrl.2014.12.016\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO'Callaghan F, Muurlink O, Reid N. Effects of caffeine on sleep quality and daytime functioning. Risk Manag Healthc Policy. 2018;11:263\u0026ndash;271.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eB\u0026aacute;nk, J., \u0026amp; M\u0026aacute;rton, S. (2000). Hungarian migraine epidemiology. \u003cem\u003eHeadache\u003c/em\u003e, \u003cem\u003e40\u003c/em\u003e(2), 164\u0026ndash;169. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1046/j.1526-4610.2000.00023.x\u003c/span\u003e\u003cspan address=\"10.1046/j.1526-4610.2000.00023.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbu-Salameh, I., Plakht, Y., \u0026amp; Ifergane, G. (2010). Migraine exacerbation during Ramadan fasting. \u003cem\u003eThe journal of headache and pain\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(6), 513\u0026ndash;517. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10194-010-0242-z\u003c/span\u003e\u003cspan address=\"10.1007/s10194-010-0242-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTorelli, P., \u0026amp; Manzoni, G. C. (2010). Fasting headache. \u003cem\u003eCurrent pain and headache reports\u003c/em\u003e, \u003cem\u003e14\u003c/em\u003e(4), 284\u0026ndash;291. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11916-010-0119-5\u003c/span\u003e\u003cspan address=\"10.1007/s11916-010-0119-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlAmri, A., AlMuaigel, M., AlSheikh, M., Zeeshan, M., Suwayyid, W., \u0026amp; AlShamrani, F. (2021). Postprandial fasting related headache during Ramadan in Saudi Arabia: A cross-sectional study. \u003cem\u003eCephalalgia: an international journal of headache\u003c/em\u003e, \u003cem\u003e41\u003c/em\u003e(11\u0026ndash;12), 1201\u0026ndash;1207. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/03331024211017915\u003c/span\u003e\u003cspan address=\"10.1177/03331024211017915\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDalkara, T., \u0026amp; Kili\u0026ccedil;, K. (2013). How does fasting trigger migraine? A hypothesis. \u003cem\u003eCurrent pain and headache reports\u003c/em\u003e, \u003cem\u003e17\u003c/em\u003e(10), 368. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11916-013-0368-1\u003c/span\u003e\u003cspan address=\"10.1007/s11916-013-0368-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eValderas, J. M., Starfield, B., Sibbald, B., Salisbury, C., \u0026amp; Roland, M. (2009). Defining comorbidity: implications for understanding health and health services. \u003cem\u003eAnnals of family medicine\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e(4), 357\u0026ndash;363. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1370/afm.983\u003c/span\u003e\u003cspan address=\"10.1370/afm.983\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChang, F. Y., \u0026amp; Lu, C. L. (2013). Irritable bowel syndrome and migraine: bystanders or partners?. \u003cem\u003eJournal of neurogastroenterology and motility\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(3), 301.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLau, C. I., Lin, C. C., Chen, W. H., Wang, H. C., \u0026amp; Kao, C. H. (2014). Association between migraine and irritable bowel syndrome: A population-based retrospective cohort study. \u003cem\u003eEuropean Journal of Neurology\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e(9), 1198\u0026ndash;1204.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMirzaei, S., Khorvash, F., Ghasemi, M., Memar-Montazerin, S., \u0026amp; Khazaeili, M. (2016). Migraine and irritable bowel syndrome: An epidemiological study. \u003cem\u003eCaspian Journal of Neurological Sciences\u003c/em\u003e, \u003cem\u003e2\u003c/em\u003e(1), 36\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi, C., Yu, S., Li, H., Zhou, J., Liu, J., Tang, W., \u0026amp; Zhang, L. (2017). Clinical features and risk factors for irritable bowel syndrome in migraine patients. \u003cem\u003ePakistan Journal of Medical Sciences\u003c/em\u003e, \u003cem\u003e33\u003c/em\u003e(3), 720.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKawashima, K., Fukuba, N., Uemura, Y., Ota, K., Kazumori, H., Sonoyama, H., Oka, A., Tada, Y., Mishima, Y., Oshima, N., Yuki, T., Katsube, T., Kinoshita, Y., \u0026amp; Ishihara, S. (2020). Comorbid irritable bowel syndrome symptoms and headache have greater association with anxiety than depression: Annual health check-up survey results. \u003cem\u003eMedicine\u003c/em\u003e, \u003cem\u003e99\u003c/em\u003e(47), e23059. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/MD.0000000000023059\u003c/span\u003e\u003cspan address=\"10.1097/MD.0000000000023059\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrover, M., Kolla, B. P., Pamarthy, R., Mansukhani, M. P., Breen-Lyles, M., He, J. P., \u0026amp; Merikangas, K. R. (2021). Psychological, physical, and sleep comorbidities and functional impairment in irritable bowel syndrome: Results from a national survey of US adults. \u003cem\u003ePloS one\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(1), e0245323.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArzani, M., Jahromi, S. R., Ghorbani, Z., Vahabizad, F., Martelletti, P., Ghaemi, A., Sacco, S., Togha, M., \u0026amp; School of Advanced Studies of the European Headache Federation (EHF-SAS) (2020). Gut-brain Axis and migraine headache: a comprehensive review. \u003cem\u003eThe journal of headache and pain\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e(1), 15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s10194-020-1078-9\u003c/span\u003e\u003cspan address=\"10.1186/s10194-020-1078-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCamilleri M. (2009). Serotonin in the gastrointestinal tract. \u003cem\u003eCurrent opinion in endocrinology, diabetes, and obesity\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(1), 53\u0026ndash;59. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/med.0b013e32831e9c8e\u003c/span\u003e\u003cspan address=\"10.1097/med.0b013e32831e9c8e\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSch\u0026uuml;rks, M., Rist, P. M., \u0026amp; Kurth, T. (2010). 5-HTTLPR polymorphism in the serotonin transporter gene and migraine: a systematic review and meta-analysis. \u003cem\u003eCephalalgia: an international journal of headache\u003c/em\u003e, \u003cem\u003e30\u003c/em\u003e(11), 1296\u0026ndash;1305. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0333102410362929\u003c/span\u003e\u003cspan address=\"10.1177/0333102410362929\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang, Z. F., Duan, Z. J., Wang, L. X., Yang, D., Zhao, G., \u0026amp; Zhang, L. (2014). The serotonin transporter gene polymorphism (5-HTTLPR) and irritable bowel syndrome: a meta-analysis of 25 studies. \u003cem\u003eBMC gastroenterology\u003c/em\u003e, \u003cem\u003e14\u003c/em\u003e, 23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1471-230X-14-23\u003c/span\u003e\u003cspan address=\"10.1186/1471-230X-14-23\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGlintborg, D., Hass Rubin, K., Nybo, M., Abrahamsen, B., \u0026amp; Andersen, M. (2015). Morbidity and medicine prescriptions in a nationwide Danish population of patients diagnosed with polycystic ovary syndrome. \u003cem\u003eEuropean journal of endocrinology\u003c/em\u003e, \u003cem\u003e172\u003c/em\u003e(5), 627\u0026ndash;638. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1530/EJE-14-1108\u003c/span\u003e\u003cspan address=\"10.1530/EJE-14-1108\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBANDAY, M., WANI, M., FAROOQ, U., PARRA, B., \u0026amp; RATHER, Y. (2020). Sociodemographic and comorbidity profiles of migraine patients: an outpatient-based study in a tertiary care hospital. \u003cem\u003eAsian Journal of Pharmaceutical and Clinical Research\u003c/em\u003e, 59\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKujanp\u0026auml;\u0026auml;, L., Arffman, R. K., Pesonen, P., Korhonen, E., Karjula, S., J\u0026auml;rvelin, M. R., Franks, S., Tapanainen, J. S., Morin-Papunen, L., \u0026amp; Piltonen, T. T. (2022). Women with polycystic ovary syndrome are burdened with multimorbidity and medication use independent of body mass index at late fertile age: A population-based cohort study. \u003cem\u003eActa obstetricia et gynecologica Scandinavica\u003c/em\u003e, \u003cem\u003e101\u003c/em\u003e(7), 728\u0026ndash;736. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/aogs.14382\u003c/span\u003e\u003cspan address=\"10.1111/aogs.14382\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamly, B., Afiqah-Aleng, N., \u0026amp; Mohamed-Hussein, Z. A. (2019). Protein-Protein Interaction Network Analysis Reveals Several Diseases Highly Associated with Polycystic Ovarian Syndrome. \u003cem\u003eInternational journal of molecular sciences\u003c/em\u003e, \u003cem\u003e20\u003c/em\u003e(12), 2959. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijms20122959\u003c/span\u003e\u003cspan address=\"10.3390/ijms20122959\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuayqil, T., Al-Jafen, B. N., Al-Saaran, Z., Al-Shammari, M., Alkthiry, A., Muhammad, W. S., Murshid, R., \u0026amp; Alanazy, M. H. (2018). Migraine and Headache Prevalence and Associated Comorbidities in a Large Saudi Sample. \u003cem\u003eEuropean neurology\u003c/em\u003e, \u003cem\u003e79\u003c/em\u003e(3\u0026ndash;4), 126\u0026ndash;134. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1159/000487317\u003c/span\u003e\u003cspan address=\"10.1159/000487317\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCaponnetto, V., Deodato, M., Robotti, M., Koutsokera, M., Pozzilli, V., Galati, C., Nocera, G., De Matteis, E., De Vanna, G., Fellini, E., Halili, G., Martinelli, D., Nalli, G., Serratore, S., Tramacere, I., Martelletti, P., Raggi, A., \u0026amp; European Headache Federation School of Advanced Studies (EHF-SAS) (2021). Comorbidities of primary headache disorders: a literature review with meta-analysis. \u003cem\u003eThe journal of headache and pain\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(1), 71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s10194-021-01281-z\u003c/span\u003e\u003cspan address=\"10.1186/s10194-021-01281-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTogha, M., Karimitafti, M. J., Ghorbani, Z., Farham, F., Naderi-Behdani, F., Nasergivehchi, S., \u0026hellip; Jafari, E. (2022). Characteristics and comorbidities of headache in patients over 50 years of age: a cross-sectional study. \u003cem\u003eBMC geriatrics\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(1), 1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYazar, T., Yazar, H. O., Ayg\u0026uuml;n, A., Karabacak, V., Altunkaynak, Y., \u0026amp; Kirbaş, D. (2021). Evaluation of serum uric levels in migraine. \u003cem\u003eNeurological sciences: official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology\u003c/em\u003e, \u003cem\u003e42\u003c/em\u003e(2), 705\u0026ndash;709. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10072-020-04598-w\u003c/span\u003e\u003cspan address=\"10.1007/s10072-020-04598-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLima Carvalho, M. F., de Medeiros, J. S., \u0026amp; Valen\u0026ccedil;a, M. M. (2017). Headache in recent onset hypothyroidism: Prevalence, characteristics and outcome after treatment with levothyroxine. \u003cem\u003eCephalalgia: an international journal of headache\u003c/em\u003e, \u003cem\u003e37\u003c/em\u003e(10), 938\u0026ndash;946. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0333102416658714\u003c/span\u003e\u003cspan address=\"10.1177/0333102416658714\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRubino, E., Rainero, I., Garino, F., Vicentini, C., Govone, F., Vacca, A., Gai, A., Gentile, S., Govone, G., Ragazzoni, F., Pinessi, L., Giordana, M. T., \u0026amp; Limone, P. (2019). Subclinical hypothyroidism is associated with migraine: A case-control study. \u003cem\u003eCephalalgia: an international journal of headache\u003c/em\u003e, \u003cem\u003e39\u003c/em\u003e(1), 15\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0333102418769917\u003c/span\u003e\u003cspan address=\"10.1177/0333102418769917\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpanou, I., Bougea, A., Liakakis, G., Rizonaki, K., Anagnostou, E., Duntas, L., \u0026amp; Kararizou, E. (2019). Relationship of Migraine and Tension-Type Headache With Hypothyroidism: A Literature Review. \u003cem\u003eHeadache\u003c/em\u003e, \u003cem\u003e59\u003c/em\u003e(8), 1174\u0026ndash;1186. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/head.13600\u003c/span\u003e\u003cspan address=\"10.1111/head.13600\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrauninger, A., Le\u0026eacute;l-Ossy, E., Kamson, D. O., P\u0026oacute;t\u0026oacute;, L., Aradi, M., K\u0026ouml;v\u0026eacute;r, F., Imre, M., Kom\u0026aacute;romy, H., Erd\u0026eacute;lyi-Botor, S., Patzk\u0026oacute;, A., \u0026amp; Pfund, Z. (2011). Risk factors of migraine-related brain white matter hyperintensities: an investigation of 186 patients. \u003cem\u003eThe journal of headache and pain\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(1), 97\u0026ndash;103. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10194-011-0299-3\u003c/span\u003e\u003cspan address=\"10.1007/s10194-011-0299-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLauritzen, M., \u0026amp; Strong, A. J. (2001). Evidence for CSD or CSD-Like Phenomena in Human Brain in Relation to Migraine and Stroke. Ischemic Blood Flow in the Brain, 335\u0026ndash;342. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/978-4-431-67899-1_41\u003c/span\u003e\u003cspan address=\"10.1007/978-4-431-67899-1_41\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMansouri, M., Sharifi, F., Varmaghani, M., Yaghubi, H., Shokri, A., Moghadas-Tabrizi, Y., Keshtkar, A., \u0026amp; Sadeghi, O. (2020). Dairy consumption in relation to primary headaches among a large population of university students: The MEPHASOUS study. \u003cem\u003eComplementary therapies in medicine\u003c/em\u003e, \u003cem\u003e48\u003c/em\u003e, 102269. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ctim.2019.102269\u003c/span\u003e\u003cspan address=\"10.1016/j.ctim.2019.102269\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNazari, F., \u0026amp; Eghbali, M. (2012). Migraine and its relationship with dietary habits in women. \u003cem\u003eIranian journal of nursing and midwifery research\u003c/em\u003e, \u003cem\u003e17\u003c/em\u003e(2 Suppl 1), S65\u0026ndash;S71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRist, P. M., Buring, J. E., \u0026amp; Kurth, T. (2015). Dietary patterns according to headache and migraine status: a cross-sectional study. \u003cem\u003eCephalalgia: an international journal of headache\u003c/em\u003e, \u003cem\u003e35\u003c/em\u003e(9), 767\u0026ndash;775. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0333102414560634\u003c/span\u003e\u003cspan address=\"10.1177/0333102414560634\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Headache, Prevalence, Jammu, North India, Migraine, Tension Type Headache","lastPublishedDoi":"10.21203/rs.3.rs-1894878/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1894878/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHeadache disorders represent a major public health problem globally. It is more in developing countries with the rising trends in young adults affecting negatively their quality of life. There has been very little information on the epidemiology of headache disorder in the Jammu division of the north Indian population.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThe present study is aimed to find out the prevalence of headache and its two major types i.e., migraine and TTH (Tension-Type Headache) in population of Jammu division.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe study was conducted in two phases: (Phase I: Face-face interview and Phase II: E-based sampling) and sufferers of headaches were incorporated into the study based on the ICHD-3 criteria for a representative sample. Frequency distribution and mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD were used in descriptive statistics to describe the data sets, while a t-test, chi-square test, and a logistic regression model using odds ratio were used in inferential statistics.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 3,148 subjects were recruited and found the overall prevalence of headache was 53.84% with a female preponderance (38.18%) in comparison to male 15.66%. Regarding the type, migraine was found to be highly prevalent (33.25%) type than TTH (20.58%). Female suffering from migraine shows the highest prevalence (25.28%). Regarding the environmental factors, bright light OR: 5.81, 95% CIs [4.96\u0026ndash;6.81] loud sound OR: 5.17, 95% CIs [4.44\u0026ndash;6.03], stress OR: 3.58, 95% CIs [3.07\u0026ndash;4.17], empty stomach OR: 3.42, 95% CIs [2.93\u0026ndash;3.98] increases the likely hood of the diseases. Also, high comorbidity association was found in between PCOS OR: 8.63, 95% CIs [3.95\u0026ndash;18.85], panic disorder OR: 5.04, 95% CIs [1.94\u0026ndash;3.05], anxiety OR: 4.53, 95% CIs [3.90\u0026ndash;5.27], IBS OR: 3.80, 95% [1.76\u0026ndash;8.23] with headache.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe prevalence of headache is high in the Jammu division of J\u0026amp;K India with migraine being the high prevalent type. Light and sound with high intensity, empty stomach, stress, and less water intake are some highly associated environmental risk factor that increases the severity diseases.\u003c/p\u003e","manuscriptTitle":"Neuroepidemiology study of headache in the region of Jammu of north Indian population","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-08-01 18:24:15","doi":"10.21203/rs.3.rs-1894878/v1","editorialEvents":[{"type":"communityComments","content":2}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7eeb9429-6530-4c1e-86a5-5193d339e17a","owner":[],"postedDate":"August 1st, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-08-05T14:44:26+00:00","versionOfRecord":[],"versionCreatedAt":"2022-08-01 18:24:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1894878","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1894878","identity":"rs-1894878","version":["v1"]},"buildId":"pf3fE39SIOqb-0xH_OWvX","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}