The Association of the Use of Electronic Media with Primary Headache in Students of the Faculty of Medicine, BaiturrahMah University Class 2017

Background: The use of multimedia-based electronics during this Covid pandemic is the right solution fordistance learning. Electronic media that are generally known by the public are cellphones and laptops/computers, and television which are communication media that use electromechanical power. Aims: To find the association between the use of electronic media with primary headaches in students of the Faculty of Medicine, Baiturrahmah University class 2017. Method: This research was an observational analytic study with a cross-sectional design. The sample of this study was the 2017 class of students who met the inclusion criteria and exclusion criteria—sampling using a non-random sampling method, namely consecutive selection. Data collection was done by distributing questionnaires. Results: In this study, the gender of the respondents, who were primarily women, was 50 people (72.5%). Respondents who experienced migraine headaches were 13 people (18.8%), and Tension-Type Headachewas 56 people (81.2%). This study showed no significant association between the use of cellphones and primary headaches in terms of frequency, duration, length of possession, position, and brightness (p>0.05). Likewise, for the use of laptops/computers, there was no significant association with primary headaches in terms of frequency, duration, length of stay, position, and brightness (p>0.05). Furthermore, there was no significant association with primary headaches for television use in terms of frequency, duration, length of stay, and position. Conclusion: There is no significant association between the use of electronic media with primary headache. University Class 2017.

Data in March 2019 showed that the most online media usage was 829 million people, namely China. The second largest was 560 million, namely India, in third place 292.89, namely the United States, fourth place was 148.06 million, namely Brazil, and fifth was 143.26 million, namely Indonesia. The latest data based on research conducted by Hendra Gunawan in 2020 found that the use of social media in Indonesia and throughout the world experienced a significant increase during the Covid 19 pandemic, where Indonesia was ranked as the third-largest in the world along with Japan and India. Internet users in Indonesia experienced a surge of around 17.3% million from 64% of the total population of Indonesia, the majority of users using mobile phones as much as 98% or equivalent to 171 million people. 4,5. The use of electronic media that is too long can result in a decrease in health. An observational study conducted by Milde-Buschet al. in 2010 stated that electronic media is one of the causes of headaches. This study is also by research conducted by Mustakim, also found in electronic media users who use cellphones for a long duration. Prolonged use can cause users to experience physical complaints such as headaches (33.3%), complaining of eye fatigue (53.3). %), difficulty resting (20%), frequent sleepiness (33.3%), and other complaints (13.3%) such as fever, shortness of breath, and body aches. Headache is a type of referred pain that originates from the deep structures to the surface of the head. Headaches are caused by several painful stimuli originating from the cranium and outside the skull, such as the nasal sinuses. Headaches are also divided into two main categories, namely primary and secondary. Primary headaches include migraine, Tension-Type Headache (TTH), and Trigeminal Autonomic Chepalgias. Secondary headaches can be divided into headaches caused by trauma to the head and neck, cranial and cervical vascular disorders, and other secondary headaches.
Based on research conducted by IkaNurwulandari (2014) worked on adolescents in Surakarta, totaling 48 respondents, 40 people (83.3%) suffered from headaches while eight people (16.7%) did not suffer from headaches. It was found that adolescents experienced headaches due to prolonged use of electronic media; the highest results were 29.2% tension headache, 29.2% miscellaneous headache, and 25.0% migraine. 1 Researchers here only examine TTH and migraine because the most common cases experienced when using electronic media are TTH and migraine and based on the pathophysiology of the factors that influence the occurrence of TTH and migraine.
Based on the above background, the author intends to research "The association of Electronic Media Use With Primary Headaches in Baiturrahmah Medical Faculty Students Class of 2017".

I. Research Methods
This research is an observational analytic study with a cross-sectional design. The sample of this study was the 2017 class of students who met the inclusion criteria and exclusion criteria-sampling using a non-random sampling method, namely consecutive selection. Data collection is done by distributing questionnaires.

II. Results
This study is an observational analytic study that aims to determine the association between the use of electronic media and primary headaches in students of the Faculty of Medicine, Baiturrahmah University class of 2017 with a total sample of 69 samples by inclusion and exclusion criteria.     Based on table 5.5, the statistical analysis results using the chi-square test showed no significant association between the frequency of cell phone use and primary headache (p=0.519). There was no criticalassociation between the duration of cell phone use and primary headache (p=0.822). There was no meaningfulassociation between the time of having a cellphone and primary headache (p=1,000). There was no significantassociation between the position of the neck or head when using a mobile phone with primary headache (p=0.422). There is nomeaningful association between cellphone screen brightness and primary headaches ( p=0.059). There was no association between the position of the neck or head when using a laptop/computer with primary headache (p=0.756). There was no association between screen brightness when using a laptop/computer and primary headache (p=0.185).

Distribution of usage characteristics of laptop/computer
In this study, the highest laptop/computer use frequency was <2x a day, totaling 39 people (56.5%). Duration 2-60 minutes 34 (49.3%). Old have >2 years 68 people (98.6%). Upright position 44 people (63.8%). Screen brightness with moderate intensity is 57 people (82.6%). This research is different from the research conducted by Ni Ketut in 2019, which obtained the longest duration of computer use, which is <3 hourstotaling 30 people (55.6%). 11

Association using a cellphone with primary headache
Based on the use of cellphones with primary headaches, in this study, the frequency of using cellphones with primary headaches (p=0.519), duration of cellphone use with primary headaches (p=0.822), duration of having cellphones with primary headaches (p=1,000), neck or head position when using a mobile phone with primary headache (p=0.422), screen brightness when using a mobile phone with primary headache (p=0.059).
This research is in line with the study conducted by Buschet al. There was also no significant association between the characteristics of cellphone use, namely the duration of cellphone use with primary headaches (p = 0.184). This study is also in line with research conducted by Surya with respondents, namely teenagers at SafiyyatulAmaliyah High School in 2012, where there is no significant relationship between the characteristics of electronic media use and primary headaches, where the frequency of cellphone use and the type of primary headache (p = 0.100), there was no significant relationship between the duration of cell phone use and the type of primary headache (p = 0.100). There was no meaningful relationship between the length of time having a cellphone and the type of primary headache (p = 0.603).
Based on research conducted by M. Hakim Darman, there is a limit to the intensity of electromagnetic wave radiation. The safest cellphone to use is a cellphone with low radiation intensity. All cellphones whose electromagnetic wave radiation intensity has been measured are still in a safe condition for health because they have not exceeded the safe limit of electromagnetic wave radiation intensity for body tissues, which is tenmW/cm2. Experts reveal that the radiation generated by mobile phones is not one hundred percent can cause health problems for humans. According to WHO, the impact of high-voltage electromagnetic waves or cellphones is not dangerous as long as the emission is negligible. Researchers the KraeftensBekaempelse interviewed 427 Danes with brain cancer and 822 people without brain tumors about cell phone use. The study results clearly show that mobile phones do not increase the risk of brain cancer at all. 15,16

Associationbetween laptop/computer use and primary headaches
In this study, the frequency of laptop/computer use with primary headaches (p=0.382), duration of laptop/computer use with primary headaches (p=0.228), duration of having a laptop/computer with primary headaches (p=1,000), position neck or head when using a laptop/computer with primary headache (p=0.756), screen brightness when using a laptop/computer with primary headache (p=0.185).
This research is in line with the study conducted by Busch et. al. There was no significant association between laptop/computer use duration and primary headache (p=0.430). This research is also in line with a study conducted by Surya with respondents, namely teenagers at SafiyyatulAmaliyah High School in 2012; there is no relationship between using a computer a day and the type of primary headache.(p=0.100). 13,14

Association of television use with primary headache
In this study, the frequency of watching television with primary headache (p=0.204), duration of watching tv with primary headache (p=0.150), duration of having a tv with primary headache (p=0.282), neck or head position while watching television were found with primary headache (p=0.395), television screen brightness with primary headache (p=0.352).
This research is in line with the research conducted by Busch et al. there was no significant relationship between television viewing duration and primary headache (p=0.140). This study is also in line with research conducted by Surya with respondents, namely teenagers at SafiyyatulAmaliyah High School in 2012; there was no significant relationship between watching television a day and the type of primary headache (p = 0.899). 13,14 According to Yao et al., 2012 the recommended distance from electronic media to be safe from electromagnetic waves is 50-70 cm or with a horizontal angle of 40 degrees and a vertical angle of 15 degrees or less.
Headaches are not only caused by electromagnetic waves but can also be caused by stress, where stress is one of the most common factors that aggravate headaches. Research reports that headaches are triggered by an increased incidence or increased pressure in everyday problems during the hours or days before the attack, with increased tension, irritability, and fatigue occurring one or more days earlier. According to Nash and Thebarge, sensitivity to stress was also associated with increased headache duration. Hormonal changes can also sometimes interact with psychological factors and are related to the timing of attacks.

IV. Conclusions and recommendations
This study found: 1. between hand trees and primary headaches regarding frequency, duration, length of possession, position, and brightness with a value (p = > 0.05). 6. There was no significant relationship between the use of laptops/computers with primary headaches in terms of frequency, duration, length of stay, position, and brightness with a value of (p=>0.05). 7. There was also no significant relationship between the use of television with primary headaches in terms of frequency, duration, length of possession, position, and brightness with a value of (p=>0.05).
Regarding the current debate regarding the relationship of electronic media use with primary headaches, the authors could not show any significant relationship between electronic media use and primary headaches. It is necessary to do further research on the relationship between the use of electronic media with more primary headaches so that the research results are better. For those who use electronic media as well as the distance from electronic media, namely with a distance of 50-70 cm or with a horizontal angle of 40 degrees and vertically 15 degrees or less and it is recommended to be more careful in using electronic media because the effects of using electronic media also have an impact on fatigue eyes, don't spend too much time busy using electronic media such as playing games or playing social media which feels like the harm is greater than the benefits, fill your spare time with dhikr to Allah or reading the Qur'an so that our time is not useless and use this electronic media as a field for us to get a reward with Allah by doing things that are beneficial for everyone.