Multifactorial Determinants of Tension Type Headache in College Students with Emphasis on Academic Stress Sleep Quality and Screen Exposure

Tension-type headache (TTH) is one of the most prevalent primary headache disorders among college students and is often aggravated by modifiable lifestyle factors, including excessive screen exposure, poor sleep quality, and academic stress. Despite the rising burden of TTH in student populations, limited evidence has systematically examined the combined influence of these factors on its prevalence and severity. The present study aimed to evaluate the association of academic stress, sleep quality, and screen time with TTH among college students in Chengalpattu district, Tamil Nadu, India. A cross-sectional study was conducted among 296 physiotherapy and pharmacy students selected through a convenience sampling approach. Data were collected using a structured online questionnaire incorporating validated tools, including the Student Academic Stress Scale for assessing stress levels and the Pittsburgh Sleep Quality Index for evaluating sleep quality. Screen exposure was assessed using a structured questionnaire, while TTH diagnosis and severity were classified according to the International Classification of Headache Disorders, third edition criteria. The mean age of participants was 19.44 ± 2.61 years. A high prevalence of daytime sleepiness and prolonged screen exposure was observed. Academic stress demonstrated a strong positive correlation with poor sleep quality (r = 0.850, p < 0.01). Increased screen time was significantly associated with higher stress levels, impaired sleep, and greater headache occurrence (p < 0.001). Overall, TTH frequency and severity were significantly linked to academic stress, sleep disturbances, and extended screen exposure. These findings highlight the importance of targeted interventions such as stress management, sleep hygiene promotion, and digital wellness strategies to reduce TTH burden and enhance student well-being.