Abstract
Objective: To find the association of tension type headache with depression in university students and its impact on their academic performance.
Methodology: This correlational study was conducted from January to June 2018 at Riphah International University, Shifa Tameer-e-Milat University, Islamic International Medical and Dental College and National University of Science and Technology, Islamabad. A total of 805 medical, engineering and social sciences students participated through non-probability convenience sampling technique with age 17-24 years. We used Headache impact Test version 6 (HIT-6) for tension type headache and depression, anxiety, stress scale (DASS). Chi square was used to determine association between DASS and HIT-6.
Results: Out of 805 students, 330(41%) were males and 475(59%) females. Mean age was 21.3±1.2 years. 254(32%)) students had headache due to loud noise, 243(30%) had anxiety, 131(16%) had headache due to exam stress, 153(19%) due to projectors light in classes and 24(3%) reported associated symptoms due to menstrual cycle. Association of academic performance with HIT-6 was negative, (r-1.28; p<0.05), whereas r values for depression, anxiety and stress with headache were positively correlated r=0.61, r=0.35, r=0.47 (p<0.05). Comparison between genders showed non-significant (p>0.05) results of HIT-6 and DASS.
Conclusion: Tension type headache was frequent and influenced the academic performance of students and they were prone to depression, anxiety and stress. Many students avoid social gathering and extracurricular activities due to headache.

Key words: Tension type headache, depression, stress, anxiety, students, academic performance.