Poor Academic Performance in University Students With Primary Headache Disorders: A Systematic Review

Introduction: Primary headache disorders, including migraines, tension-type headaches, and cluster headaches, significantly impact university students′ academic performance through absenteeism, lack of concentration, reduced productivity, and poor grades. This systematic review aims to determine the proportion of university students with impaired academic performance due to primary headache disorders. Methods: The review protocol is registered in PROSPERO (CRD42023414524). We conducted a systematic review following the PRISMA guidelines. Cross-sectional observational studies assessing academic performance in university students with primary headache disorders were included. We excluded studies on secondary headaches, studies involving mixed populations (i.e., those combining university students with schoolchildren or postgraduate students without separate data), and intervention designs. We searched in multiple databases including MEDLINE, EMBASE, SCOPUS, PsycInfo, and Web of Science, up to January 3, 2023. Search strategies were developed incorporating keywords related to “headache disorders,” “cephalalgia,” and “academic performance.” Two independent reviewers conducted study selection and data extraction, with disagreements resolved by a third reviewer. We used the Joanna Briggs Institute (JBI) tool for prevalence studies to assess the risk of bias. Due to study heterogeneity, meta-analyses were not feasible, and a narrative synthesis was performed. Results: Twelve cross-sectional observational studies with 8685 participants (predominantly female, 74%) were included. Migraine was the most reported headache type (83%). According to the JBI tool, only one study had a low risk of bias, while most showed moderate to high bias levels. Among students with primary headache disorders, 53% exhibited poor academic performance, 18% reported low productivity, 14% low concentration, 11% absenteeism, and 4% below-average grades. Conclusion: A substantial proportion of university students with primary headache disorders show impaired academic performance, with poor performance being the most frequent outcome. This review highlights the need for further research with standardized assessment tools to better quantify and address the academic impact of primary headache disorders.