Work-related well-being and primary headache disorders among Japanese nurses: a cross-sectional structural equation modeling study.

Acute care hospital nurses face occupational conditions linked to headache, including shift work and psychosocial stress, but pathways from work-related well-being (WRWB) to primary headache disorders remain uncharacterized in occupational settings. This cross-sectional study estimated the 1-year prevalence of primary headache disorders among 247 nurses from two acute care hospitals in Japan and examined whether WRWB is indirectly associated with headache outcomes via psychological health and sleep. Headache was classified according to the International Classification of Headache Disorders, 3rd edition. WRWB comprised work engagement, job satisfaction, and work-life balance satisfaction. Structural equation modeling was used to estimate indirect associations. The 1-year prevalence was 85.8% for any primary headache disorder, 35.2% for migraine, and 43.3% for tension-type headache (TTH). WRWB had indirect associations with any primary headache disorder (standardized β=-0.65, p<0.001), migraine (β=-0.85, p<0.001), and TTH (β=-0.60, p=0.015), but no direct associations. Pathways differed by subtype: migraine via psychological health (β=-0.47, p=0.004) and insomnia symptoms (β=-0.36, p=0.003), whereas TTH only via sleep duration (β=-0.10, p=0.041). Findings support integrating organizational and individual approaches into occupational headache management for nurses.