Headache Burden, Healthcare-seeking Behaviour and Self-referral Practices among Secondary School Teachers in Ekiti State, Nigeria

Abstract

Background: Headache disorders are among the leading causes of disability worldwide and contribute substantially to reduced quality of life, impaired work productivity, and increased healthcare utilisation. Despite their high burden, many individuals rely on self-medication or delay seeking professional care. Teachers represent an occupational group that may be particularly vulnerable because of work-related stress and prolonged cognitive demands. Aims: This study assessed headache burden, knowledge of headache red-flag symptoms, healthcare-seeking behaviour, and factors associated with self-referral among secondary school teachers in Ekiti State, Nigeria. Methods: A descriptive cross-sectional study was conducted among 342 secondary school teachers selected using multistage sampling between January and April 2026. Data were collected using a structured, pretested, self-administered questionnaire. Descriptive statistics summarised participant characteristics, while chi-square tests and multivariable logistic regression identified factors independently associated with self-referral. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Statistical significance was set at p < 0.05. Results: Overall, 239 respondents (69.9%) reported experiencing headache within the preceding three months. Among those affected, 57.3% experienced headaches daily or weekly, 26.3% reported severe headaches, and headaches interfered with teaching activities in 50.2% and resulted in work absenteeism in 35.6%. Only 30.7% demonstrated good knowledge of headache red-flag symptoms. Although 76.3% indicated that they would seek medical care for severe headache, only 45.0% had consulted a healthcare provider during the previous year. Severe headache (AOR 2.84, 95% CI 1.61–5.01), frequent headache episodes, work interference, recognition of headache red-flag symptoms, and good knowledge were independently associated with self-referral, whereas barriers to healthcare reduced the likelihood of self-referral. Conclusion: Headache is highly prevalent among secondary school teachers and has important occupational consequences. Deficiencies in headache literacy, delayed healthcare utilisation, and widespread self-medication highlight the need for targeted educational interventions and strengthened primary healthcare services to promote timely evaluation and appropriate referral.