Impact of 24-Hour On-Call Shifts on Headache in Medical Residents: A Cohort Study.

Abstract

During 24-hour on-call shifts medical residents are exposed to diverse circumstances such as sleep deprivation and stress. Our aim is to assess the effect of 24-hour on-call shifts on medical residents' headache-related disability. The Migraine Disability Assessment Scale (MIDAS), the Headache Impact Test (HIT-6), the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS) questionnaires were administered to medical residents who had never performed on-call shifts at baseline and 6 months after beginning 24-hour on-call shifts. Scores were compared. About 66 medical residents completed this study. About 21.2% (n=14) had history of migraine, 42.4% (n=28) had a history of tension-type headache (TTH) and 12.1% (n=8) had a history of both migraine and TTH. Among medical residents with migraine, the median MIDAS score was significantly higher after starting 24-hour on-call shifts than at a baseline (4.0 vs 8.0; Wilcoxon, P=.001), meaning that, on average, disability increased from little or no disability, to moderate disability. No difference in HIT-6 scores was found. The median score of PSQI and HADS was higher at 6 months (PSQI: 7.0 vs 8.0; P=.003), (HADS: 5.0 vs 8.0; P<.001) for the general group. In medical residents with migraine, migraine-related disability increased after starting 24-hour on-call shifts. We also found a worsening in depression and anxiety symptoms and self-reported sleep quality in medical residents with and without headache history.