Headache education in medical schools in Türkiye: the perspective of final-year medical students

Abstract

Background

Healthcare professionals’ knowledge and training are important contributors to adequate medical care for headache disorders. Since most headaches are treated in primary care, undergraduate medical education represents an important stage for strengthening headache-related knowledge and clinical preparedness. This study aimed to evaluate headache education among final-year medical students in Türkiye.

Methods

This cross-sectional, web-based survey study was conducted among final-year medical students from ten medical faculties in Türkiye between June and December 2022. A 32-item questionnaire developed by the authors was used to assess headache-related educational exposure, self-reported preparedness, and theoretical knowledge. Thirteen knowledge-based questions were used to calculate the total knowledge score. Descriptive statistics, group comparisons, and Spearman correlation analysis were performed.

Results

A total of 523 final-year medical students participated. The mean knowledge score was 9.14 ± 1.87 out of 13. Although 94.8% reported receiving headache education, only 46.5% had received outpatient clinic-based training, 11.7% had attended a headache subspecialty clinic, and 9.6% were familiar with the national headache guideline. Participants who had received didactic headache education scored higher than those who had not (9.18 vs. 8.37; mean difference 0.81, 95% CI 0.09 to 1.54; p = 0.019), as did those who had received outpatient clinic-based training (9.38 vs. 8.93; mean difference 0.45, 95% CI 0.13 to 0.77; p = 0.009) and those who had received structured instruction on headache history-taking (9.30 vs. 8.58; mean difference 0.72, 95% CI 0.34 to 1.11; p = 0.001). Higher total headache-related lesson time was weakly but significantly correlated with higher knowledge scores (Spearman’s rho = 0.12, 95% CI 0.04 to 0.21; p = 0.005). Most participants reported feeling insufficiently prepared to treat pregnant women with migraine, as well as pediatric and geriatric patients with migraine.

Conclusions

The findings suggest that undergraduate headache education in Türkiye may benefit from further curricular strengthening, particularly through structured teaching, clinical exposure, and improved familiarity with headache management guidelines. Further studies using validated tools and longitudinal designs are needed to evaluate the educational and clinical impact of such interventions.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12909-026-09683-w.

Background

Headache disorders are nearly universal, with most individuals experiencing headache at some point in their lives. The Global Burden of Disease (GBD) study highlighted migraine and tension-type headache as among the most prevalent disorders worldwide and identified migraine as a leading cause of disability, particularly among young adults aged 15–49 years. Data from the GBD Study 2021 have further quantified this burden, demonstrating that headache disorders affect an estimated 3.1 billion people globally, corresponding to nearly 40% of the world’s population at any given time [1]. Migraine and tension-type headache remain among the most prevalent neurological conditions worldwide, with migraine continuing to rank among the top causes of years lived with disability (YLDs), especially in individuals of working age [1, 2].

Despite this substantial and well-documented global burden, a large proportion of individuals disabled by headache disorders do not receive effective or appropriate healthcare. Although epidemiological estimates have improved, significant gaps persist in healthcare delivery, access to trained professionals, and allocation of resources for headache care. These barriers vary across regions but are consistently driven by insufficient awareness, limited educational exposure, and competing healthcare priorities [2–4].

The World Health Organization (WHO) has long emphasized the global neglect of headache disorders. The WHO Atlas of Headache Disorders and Resources in the World highlighted inadequate education and training of healthcare professionals as among the most critical obstacles to effective headache management. Importantly, the Atlas underscored that investment in well-organized headache services supported by structured education is likely to be cost-effective, given the high indirect costs associated with headache-related disability [3]. Nevertheless, headache education continues to receive limited attention within undergraduate medical curricula and specialist training programs worldwide [2–4].

Education is a central pillar of effective headache services. Professional education should focus on the relatively small number of headache disorders of major public health importance to minimize delayed or missed diagnoses and to support early and appropriate therapeutic intervention. Improved professional education has been shown to enhance the use of available treatments, improve patient outcomes, reduce unnecessary investigations, and encourage follow-up, which is often neglected but essential for optimal care [5, 6]. Because most headache disorders are managed in primary care settings, the foundation of professional education should be established during undergraduate medical training, followed by continuing medical education for general practitioners. Insufficient education and training in headache medicine may contribute to diagnostic errors, inappropriate treatment strategies, and low patient satisfaction among individuals with headache disorders [5, 6].

Against this background, the present study aimed to evaluate the current status of headache education among final-year medical students in Türkiye by examining their educational exposure, knowledge level, and perceptions regarding the diagnosis and management of migraine.

Methods

Study design and setting

This study was designed as a cross-sectional, web-based survey conducted among final-year medical students from ten medical faculties in Türkiye. The survey was implemented over a six-month period between June and December 2022. The study aimed to evaluate headache-related educational exposure, theoretical knowledge, and self-reported preparedness for the diagnosis and management of headache disorders.

Design of a web-based questionnaire

A detailed questionnaire, developed by the authors specifically for this study, was designed to evaluate multiple aspects of the current undergraduate medical curriculum related to headache disorders. The questionnaire assessed participants’ basic knowledge of headache disorders, explored their perceptions of the adequacy of their exposure during training, and determined their level of comfort in diagnosing and treating various migraine groups.

The questionnaire was web-based and comprised 32 items. Thirteen items assessed theoretical knowledge of migraine and headache disorders and were used to calculate the total knowledge score. The remaining items collected information on demographic characteristics, headache-related educational exposure, duration and type of training, familiarity with headache guidelines, and self-reported preparedness for managing migraine in specific patient groups, including pregnant, pediatric, and geriatric patients. Participants were also asked to report the approximate number of instructional hours devoted to headache disorders and to diabetes and its complications. This comparison was included to contextualize headache education relative to another common chronic condition frequently encountered in clinical practice. The questionnaire items are provided in the Supplementary File.

The questionnaire was developed specifically for this study by senior neurologists with expertise in headache disorders and medical education. The initial item pool was reviewed and refined through expert consensus to ensure that the questions reflected clinically relevant aspects of undergraduate headache education, including educational exposure, theoretical knowledge, and self-reported preparedness. Prior to dissemination, the questionnaire was pilot-tested for clarity, comprehensibility, and face validity by five fifth-year medical students who were not included in the final analysis. Minor linguistic and structural modifications were made based on their feedback. The number of items was limited to optimize completion and reduce response fatigue. To improve data reliability and prevent duplicate responses, single-use survey links were used.

Given the exploratory and descriptive nature of the study, no formal psychometric validation or factor analysis was performed. The questionnaire was primarily designed to capture self-reported educational exposure, perceptions, and basic theoretical knowledge rather than to serve as a standardized psychometric assessment tool. The 13 knowledge-based items were intended to sample different aspects of headache and migraine knowledge (including classification of primary headaches, acute treatment, prophylactic treatment, and neuroimaging) rather than to constitute a unidimensional scale. As the knowledge score was treated as a continuous variable, internal consistency was nonetheless examined using Cronbach’s alpha and McDonald’s omega. Two items that correlated negatively with the total score (prophylactic use of calcium-channel blockers and antiepileptics) were reverse-scored prior to analysis, after which Cronbach’s α was 0.40 and McDonald’s ω was 0.43. As expected for a knowledge test sampling multiple content domains, these internal-consistency coefficients were low and were therefore interpreted with caution. Because the items were designed to assess heterogeneous aspects of headache and migraine knowledge rather than a single latent construct, these findings further support the need for formal psychometric development and validation in future studies.

Study participants and sampling

Eligible participants were final-year medical students from ten medical faculties located in different regions of Türkiye. We employed a non-probability convenience sampling approach. Participants were recruited through student networks, faculty-based student groups, and social media platforms, including WhatsApp and Instagram. The web-based survey link, which was compatible with smartphones, was distributed through available student communication channels at the participating faculties and was periodically re-shared during the study period to increase reach. Participation was voluntary and anonymous.

Because recruitment was conducted online using a non-probability convenience sampling approach, students who were more active on social media platforms or more interested in headache education may have been more likely to participate, which may have introduced selection bias. To improve accessibility and reduce response burden, the survey was smartphone-compatible and the number of items was limited. To improve data reliability and prevent duplicate responses, single-use survey links were used.

Being in the final year of their six-year medical education course, the included students were considered able to provide a more comprehensive assessment of their headache-related undergraduate educational experience.

In the absence of a priori sample size calculation, the achieved sample size of 523 participants provides an approximate precision of ± 4.3% at the 95% confidence level for a proportion of 50%. Therefore, the sample was considered adequate for the descriptive and exploratory objectives of this study.

Study period

The duration of survey implementation was planned as 6 months, starting in June 2022 and ending in December 2022. To draw the utmost attention of all anticipated participants in each medical faculty, the survey’s link was periodically re-shared over the 6-month window to maximise reach.

Ethical considerations

The study was conducted in accordance with the Declaration of Helsinki, and ethical committee approval was obtained from Istanbul Medipol University Non-Interventional Ethical Research Board (Decision No: 421 − 11/05/2022). Informed consent was obtained electronically prior to the survey. Participants were informed that their data would be kept confidential and that their responses would remain anonymous.

Statistical analysis

The data were analysed using the Jamovi software (version 2.3.28). Descriptive statistics included the mean, standard deviation, minimum, and maximum for numerical variables, and frequencies and percentages for categorical variables. The number of correct answers to the 13 questions measuring knowledge level was treated as a continuous variable. For comparisons between two groups, the t-test was used for parametric data, and the Mann–Whitney U test was used for non-parametric data. For variables with more than two categories, one-way ANOVA or the Kruskal–Wallis test was used, depending on whether the data were parametric or non-parametric. To assess the relationship between two continuous variables, Spearman’s correlation analysis was performed. In all analyses, a statistical significance level of p < 0.05 was considered. The number of correct responses to the 13 knowledge-based questions served as an indicator of theoretical knowledge of headache disorders. This measure was not intended to assess clinical decision-making, diagnostic reasoning, or real-life management competence, but rather to provide an objective approximation of core guideline-oriented knowledge within the undergraduate medical context. Given the exploratory nature of the study and the predefined focus on educational exposure variables, analyses were primarily conducted using univariable comparisons to identify patterns of association rather than to build predictive multivariable models.

Results

Demographic characteristics of participants

A total of 523 final-year medical students completed the questionnaire and were included in the analysis. The mean age of the participants was 24.3 years (SD = 1.89, min:20, max:46). Of the participants, 224 were male (42.8%), and 299 were female (57.2%). Of the participants, 71.1% (n = 372) were studying medicine at a state university, 28.9% (n = 151) at a private university, 7.8% (n = 41) in English, and 92.2% (n = 482) in Turkish (Table 1).

Table 1.

Demographics of the questionnaire study

Participants	n	(%)
Gender
Female	299	(57.2%)
Male	224	(42.8%)
Age-range	20-46	(Mean; 24.3)
Number of studying
State University	372	(71.1%)
Private University	151	(28.9%)
Numbers of studying
Medicine in Turkish	482	(92.2%)
Medicine in English	41	(7.8%)

Values are presented as n (%) unless otherwise stated. Age is presented as mean and range

Current status and coverage of headache education

Overall, 94.8% of participants reported having received education on headache, while 46.5% had received training in outpatient clinics. Exposure to problem-based learning (PBL) was reported by 27.9% of participants. Of those who received education on headache, 69.4% had received it through the student internship programme and 5.5% through the elective programme. The proportion of participants who attended a headache subspecialty clinic during their training was 11.7%. The rate of being familiar with the ‘Headache Diagnosis and Treatment Current Approaches Guideline’ published by the Headache Study Group of the Turkish Neurological Association was 9.6% (50 participants) (Table 2). Regarding the duration of education on headache, 60 people received 1 h of education, 129 people received 2 h of education, 69 people received 3 h of education, 76 people received 4 h of education, and 175 people received more than 4 h of education. Regarding the duration of education on diabetes and related complications, 19 people received 1 h, 31 people received 2 h, 31 people received 3 h, 16 people received 4 h, and 411 people received more than 4 h. The total number of hours of education about diabetes and its complications was significantly higher than the total number of hours of education about headache (Fig. 1).

Table 2.

Comparison of knowledge scores (number of correct answers out of 13 questions) according to headache-related educational experiences

	Yes			No			Mean difference	95% CI	p value
	n (%)	Mean	SD	n (%)	Mean	SD
Received educational lectures about headaches	496 (94.8)	9.18	1.87	27 (5.2)	8.37	1.80	0.81	0.09 to 1.54	0.019
Received education in the outpatient headache clinic	243 (46.5)	9.38	1.82	280 (53.5)	8.93	1.90	0.45	0.13 to 0.77	0.009
Received explanatory training on taking a complete headache history	410 (78.4)	9.30	1.79	113 (21.6)	8.58	2.05	0.72	0.34 to 1.11	0.001
Attended a headache subspecialty clinic during training	61 (11.7)	9.49	1.86	462 (88.3)	9.10	1.87	0.40	−0.10 to 0.90	0.113
Familiar with the “Current Approaches to Headache Diagnosis and Treatment Guideline”	50 (9.6)	9.56	1.91	473 (90.4)	9.10	1.87	0.46	−0.08 to 1.01	0.112
Participated in online training on headaches	92 (17.6)	9.05	2.09	431 (82.4)	9.16	1.83	−0.11	−0.53 to 0.32	0.900
Had PBL related to headache	146 (27.9)	9.24	1.80	377 (72.1)	9.10	1.90	0.14	−0.22 to 0.50	0.481

Values are presented as n (%) and mean ± standard deviation of the number of correct answers (out of 13 knowledge questions). Percentages are calculated over the total sample (N = 523)

CI confidence interval, SD standard deviation, PBL problem-based learning

p values were obtained using the Mann–Whitney U test, as the assumption of normality was violated for all variables (Shapiro–Wilk test, p < 0.001). Mean differences and their 95% confidence intervals were derived from the independent samples t-test to indicate the magnitude and direction of the between-group differences

Bold values indicate statistical significance (p < 0.05)

Fig. 1.

Comparison of the total number of hours exposed to headache disorders as compared to diabetes mellitus and its complications

The number of medical students who received training on taking a headache history was 410 (78.4%). Training in headache diagnosis was considered adequate by 110 (21%), theoretical but not practical by 104 (19.9%), partially adequate by 231 (44.2%), and inadequate by 75 (14.3%). Regarding the management of pregnant women with migraine, 20.2% of the participants reported that they could treat such patients with ease, 57.3% stated that they could manage them partially with consultation, while 22.5% indicated that they felt inadequate. In pediatric migraine cases, 6.1% of participants considered themselves competent, 24.1% partially competent, whereas the majority (69.7%) perceived themselves as inadequate. Similarly, for the management of elderly patients with migraine, 6.1% felt competent, 34.5% partially competent, and 59.4% reported feeling inadequate.

Among participants who responded to the item on the perceived usefulness of online education (n = 261), 47 (18.0%) found it useful, 164 (62.8%) found it partially useful, and 50 (19.2%) found it not useful. The proportion of participants who had the opportunity to attend online headache training sessions was 17.6% (n = 92). In response to the item on specific platforms, 38 participants reported attending “Doctorclub online courses,” whereas 10 reported attending courses delivered through their own university websites.

Headache-related knowledge scores

The mean number of correct answers was 9.14 (SD = 1.87, min:3, max:13) to the 13 questions measuring knowledge about headache. (Fig. 2) Analysis of responses to the 13 knowledge-assessing questions revealed no significant difference between students from state versus private universities (p = 0.447) or between those studying medicine in English versus Turkish (p = 0.321). Participants who had received didactic courses on headache provided significantly more correct responses than those who had not (p = 0.019). These differences are further illustrated in Fig. 3, where participants who reported receiving formal didactic education on headache disorders demonstrated an upward shift in the distribution of correct answer scores compared with those without such exposure. Likewise, participants who had received training in outpatient headache clinics performed significantly better (p = 0.009), and those who had received structured training on obtaining a complete headache history also gave significantly more correct responses (p = 0.001). As shown in Fig. 4, structured instruction on headache history-taking was associated with higher median knowledge scores and a broader distribution toward higher performance levels. No significant differences were observed between those who had attended a subspecialty headache clinic during training and those who had not (p = 0.113), nor between participants familiar and unfamiliar with the “Guideline on Current Approaches to Diagnosis and Treatment of Headache” published by the Turkish Neurological Association Headache Study Group (p = 0.112). Similarly, no significant differences were found between participants in online headache education programs and those who did not (p = 0.900), nor between students who engaged in PBL and those who did not (p = 0.481). Participation rates in these educational modalities were relatively low: 17.6% reported attendance in online headache training programs and 27.9% reported exposure to problem-based learning activities related to headache disorders.

Fig. 2.

Relationship between total headache-related lesson hours and correct answer scores

Fig. 3.

Distribution of correct answer scores according to exposure to formal didactic education on headache disorders

Fig. 4.

Distribution of correct answer scores according to structured training on headache history-taking

Perceived adequacy and preparedness regarding headache education

Only 21% of participants (n = 110) considered their headache education sufficient. While 19.9% (n = 104) perceived the training as theoretically adequate but lacking practical components, 44.2% (n = 231) rated it as partially sufficient, and 14.3% (n = 75) reported it as insufficient. Table 3 summarizes participants’ perceived competence in headache education.

Table 3.

Participants’ perceived levels of competence regarding headache education

Perception of Educational Adequacy	Number of Participants (%)
Adequate	110 (21.0)
Theoretical but not practical	104 (19.9)
Partially Adequate	231 (44.2)
Inadequate	75 (14.3)
Total	523 (100)

Values are presented as n (%)

Furthermore, no significant association was detected between receiving headache education during internship/elective rotations and the number of correct responses (p = 0.362). However, participants who considered the headache diagnosis training they received to be adequate [whether theoretical and practical (p = 0.001) or only theoretical (p = 0.038)] provided significantly more correct responses than those who rated the training as inadequate. A positive correlation was found between the total duration of headache-related education and the number of correct responses (Spearman’s rho = 0.12, 95% CI 0.04 to 0.21; p = 0.005) (Fig. 2). Moreover, participants who felt competent in treating pregnant or elderly patients with migraine provided significantly more correct answers than those who did not (p = 0.001, p = 0.027).

Discussion

The results of this study highlight substantial gaps in headache education within Turkish medical faculties. Despite the high prevalence and burden of headache disorders, our findings indicate that final-year medical students receive insufficient training in this area. Most participants reported feeling inadequately prepared to diagnose and manage headache disorders. These findings are consistent with previous reports indicating limited undergraduate exposure to headache education and insufficient preparedness in headache diagnosis and management [2, 6]. These findings suggest that undergraduate headache education may benefit from further curricular strengthening, particularly through structured theoretical teaching and clinically oriented training.

The findings show remarkable consistency with survey studies conducted in other countries on headache education. For example, a similar study conducted among medical students in Singapore found that more than half (55.1%) had not received formal training in taking a complete headache history, and 90.6% had not visited a headache outpatient clinic. Furthermore, 62.2% of Singaporean students considered themselves inadequate in diagnosing and managing headaches [2]. An earlier study conducted in the United States in 2005 indicated that headache curriculum in medical education was limited, that medical school course hours were generally minimal, and that 92% of institutions had no plans to increase headache education. Although medical schools consider their education adequate, both neurology and family medicine residency programme directors believe that residents entering the programme are not sufficiently prepared in headache [6].

Taken together with previous studies from Singapore and the United States, our findings suggest that limited exposure to headache education among medical students may not be unique to Türkiye but may reflect a broader challenge in medical education. Common deficiencies include limited clinical experience, inadequate training in basic clinical skills such as taking a medical history, and a widespread perception among students that they are not prepared to diagnose and treat headache disorders. The discomfort reported by students in Türkiye regarding headache treatment in special populations (pregnant, paediatric, and geriatric patients) is also seen in the Singapore study (79.5% for pregnant patients with migraine; 48% for older adults with migraine) [2]. This highlights that managing headaches in special populations is insufficiently addressed in the curriculum.

Some key factors influenced students’ knowledge levels. The visual distribution of knowledge scores further supports the quantitative findings. Participants exposed to formal didactic teaching and structured instruction on headache history-taking consistently demonstrated higher median scores and an upward shift in overall performance. These patterns suggest that educational interventions emphasizing structured content delivery and clinically oriented instruction may be more influential than fragmented or optional learning experiences. It is important to emphasize that the knowledge scores obtained in this study represent theoretical understanding rather than comprehensive clinical competence. Clinical proficiency in headache management requires not only factual knowledge but also diagnostic reasoning, longitudinal patient follow-up, and contextual decision-making, which cannot be fully captured through a questionnaire-based assessment. Therefore, while higher knowledge scores were associated with structured educational exposure, these findings should be interpreted as indicators of educational adequacy rather than direct evidence of clinical readiness.

Receiving structured headache training, outpatient clinic exposure, and greater total lesson hours were positively associated with students’ scores on headache-related knowledge questions. This finding supports the potential value of structured and clinically oriented headache education within undergraduate medical curricula. However, these associations should be interpreted cautiously, as the knowledge score reflects theoretical knowledge rather than direct clinical competence. These findings align with previous research showing that increased educational exposure improves clinical competency in headache management [7]. However, the magnitude of these differences was modest, ranging from approximately 0.45 to 0.81 correct answers out of 13 (roughly 3–6% of the total score), with upper confidence limits not exceeding about 1.5 points. Differences of this size, although statistically significant in a large sample, are unlikely to represent an educationally meaningful gain at the individual level and may instead reflect the incremental contribution of any single educational exposure. This further supports the view that coordinated, structured, and clinically integrated education—rather than isolated interventions—is likely needed to achieve substantive improvements in headache knowledge.

Our study also highlights the large gap between headache education and the education hours for other common diseases, such as diabetes. While 411 participants received more than four hours of diabetes-related education, only 175 students had a comparable amount of training for headache disorders. This difference in teaching hours suggests that headache education may receive less curricular emphasis than some other common chronic conditions in medical faculties in Türkiye. Despite the high prevalence of headache disorders and the significant burden they place on public health and economies [1, 3], they receive disproportionately less educational attention compared to other chronic conditions. This imbalance in teaching hours may contribute to reduced preparedness among future physicians and may partly explain difficulties in the recognition and management of headache disorders in primary care settings. International studies, as reported by Ashina et al., corroborate this situation, reporting misdiagnosis rates exceeding 70% in primary care settings and a significant under prescription of migraine prophylaxis by general practitioners [8]. The difference in training hours identified in our study is a recurring phenomenon in the Singapore study and is thought to be a widespread issue in medical education [2]. This educational imbalance may affect future clinicians’ preparedness to manage a common public health problem. These findings suggest that curriculum developers should consider the epidemiological burden and clinical impact of headache disorders when allocating teaching time within undergraduate medical education.

Additionally, in the present study, participation in PBL activities and online educational programs was not associated with higher knowledge scores. This finding should be interpreted with caution. The absence of a statistically significant association does not indicate that these educational approaches are ineffective; rather, it highlights the limitations of the current assessment framework. Information regarding the content, duration, educational quality, learner engagement, and assessment alignment of PBL sessions and online modules was not systematically collected. Consequently, it is not possible to determine whether these modalities were inadequately implemented, insufficiently integrated into the curriculum, or simply not captured by the knowledge-based outcome measures used in this study.

Only a minority of students reported participation in online headache training (17.6%) or PBL activities related to headache disorders (27.9%). Previous studies have suggested that PBL and digital learning tools can be effective when they are longitudinal, interactive, and aligned with learning objectives and assessment strategies [9, 10]. However, in the present study, the educational “dose” and quality of these interventions could not be systematically evaluated, as online education was delivered through diverse platforms, including commercial programs and institution-specific resources, without standardized curricula or assessment frameworks. Therefore, the discrepancy between previous reports and the present findings is more likely attributable to variability in implementation and limited curricular integration rather than to an inherent lack of educational value. Only 9.6% of students were familiar with the Turkish Neurology Association’s “Current Approaches to Headache Diagnosis and Treatment Guide,” and this familiarity was not significantly associated with better test performance (p = 0.112). Similarly, participation in online headache training modules was not associated with higher knowledge scores (p = 0.900), suggesting that stand-alone or insufficiently integrated learning modalities, particularly when delivered with limited exposure, may be insufficient to address gaps in undergraduate headache education [10, 11]. Future studies should incorporate standardized descriptions of educational interventions, exposure duration, and outcome measures that extend beyond factual knowledge to better capture their potential impact on clinical reasoning and preparedness.

This study utilised a web-based questionnaire to measure participants’ knowledge and perceptions based on their past education. This methodology is susceptible to memory bias, in which participants may inaccurately recall their educational experiences, as well as to social desirability bias, in which responses may reflect perceived expectations rather than genuine beliefs. Although multivariable modelling was not the primary aim of this study, future research using longitudinal designs may further clarify the independent contribution of different educational components. Additionally, the questionnaire used in this study was specifically developed for this research and was not subjected to full psychometric validation. Although efforts were made to enhance content and face validity through expert review and pilot testing, the absence of full psychometric validation, including formal reliability testing and construct validity assessment, limits the interpretability of the knowledge scores. Therefore, the results should be interpreted as reflecting relative differences in educational exposure and self-reported preparedness rather than absolute measures of clinical competence. This cross-sectional study provides a snapshot of headache education at a single point in time and cannot track the long-term effects of the education received.

Although 523 participants constitute a large sample, recruitment via social media platforms may introduce selection bias. Students who use social media more actively or are more interested in headache education may be more likely to participate, potentially limiting the generalizability of the findings to the entire population of final-year medical students in Türkiye. Headache knowledge was assessed using 13 specific questions. Although these questions aimed to measure relevant knowledge, they may not comprehensively demonstrate the clinical reasoning, diagnostic accuracy, or management skills required for effective headache care. Finally, the study did not collect detailed data on the content of ‘structured headache education,’ “PBL” sessions, or ‘online training modules.’ This limits the ability to definitively determine why specific methods are effective or ineffective and makes it difficult to provide specific recommendations for curriculum adjustments. Further research is needed to eliminate selection and memory bias and to determine the effectiveness or ineffectiveness of educational methods.

In light of these findings, we propose revising the current undergraduate medical curriculum in Türkiye to include more structured education on headache. Hands-on clinical training, case-based learning, and interactive workshops should be prioritised to improve medical students’ preparedness for headache diagnosis and management. Future studies should formally and objectively map headache-related curricular content, teaching hours, clinical exposure, and educational methodologies across medical faculties to better identify gaps and guide targeted curriculum reform.

Conclusion

This study suggests that headache education in Turkish medical schools may benefit from further improvement. Despite the substantial burden of headache disorders, our findings indicate that current undergraduate training may not provide sufficient structured clinical exposure and practical preparation for the diagnosis and management of headache disorders. The observed association between structured headache training and higher knowledge scores supports the potential value of curriculum revisions that prioritise practical and interactive learning methods.

To address this potential educational gap, medical schools may consider implementing standardised headache training modules, integrating headache education into core curricula, and emphasising clinical exposure through outpatient rotations. In addition, greater efforts may be warranted to increase students’ familiarity with national and international headache management guidelines.

Future research should investigate the long-term impact of improved headache education on patient outcomes. Addressing these deficiencies may help improve the quality of headache care, reduce diagnostic delays, and ultimately improve the overall management of headache disorders in Türkiye.

Abbreviations

GBD

Global burden of disease

YLDs

Years lived with disability

DALYs

Disability-adjusted life years

HALE

Healthy life expectancy

WHO

World health organization

PBL

Problem-based learning

Authors’ contributions

Conception and research design: BP, AÖ and ET.Data Collection: BP, SB, PYD, ÖK and AÖ.Data analysis: ET.Draft manuscript: BP, ET and HŞ.Revised manuscript: BP and HŞ.Corresponding Author: Halime Şahan.

Funding

Not applicable.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

The study was conducted in accordance with the Declaration of Helsinki, and ethical committee approval for this study was obtained from Istanbul Medipol University Non-Interventional Ethical Research Board (Decision No: 421 − 11/05/2022). Informed consent was obtained electronically prior to the survey.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.