BACKGROUND: Migraine is a common primary headache disorder that significantly affects academic life and is often associated with stress, depression, anxiety, and irregular sleep patterns among university students. This study aimed to assess the prevalence of migraine among King Khalid University (KKU) students, identify its determinants, and evaluate the impact of migraine and other headaches on academic life and performance. METHODS: An analytical cross-sectional study was conducted among 732 students from Colleges of Medicine, Pharmacy, Engineering, and Computer science. We used a self-administered questionnaire, including the ID Migraine™ screening tool, which was administered either through an online survey or face-to-face. Convenience and snowball sampling methods were adopted to recruit participants between June 1 and August 31, 2024. RESULTS: The median [interquartile range (IQR)] age was 21(2.0) years, 58.2 % were female, 97.5 % were Saudi, and 93.0 % were non-smokers. The prevalence of migraine was 44.1%. The key predictors of migraine were female gender (adjusted odds ratio (AOR) = 1.78 (1.29 - 2.46), P <
0.001), family history AOR = 2.39 (1.75- 3.27), P <
0.001], working alongside education (AOR = 1.95 (1.19 - 3.18), P = 0.007), family debt (AOR = 1.86 (1.06 - 3.29), P = 0.03), and having chronic diseases like bronchial asthma (AOR = 2.16 (1.11 - 4.20), P = 0.02) and hypertension AOR = 6.23 (1.34 - 28.84), P = 0.01). Over 90 % reported migraines affected concentration, sleep, and exam preparation, and 65 % indicated an impact on university attendance. CONCLUSIONS: Migraines are highly prevalent among KKU students, affecting academic daily life. Early detection and lifestyle changes are essential, and universities should plan and implement coping strategies to support affected students.