The prevalence of headache disorders in children and adolescents in Ethiopia: a schools-based study

DOI: https://doi.org/10.1186/s10194- 020- 01179- 2

Abstract-Summary The Global Burden of Disease (GBD) study establishes headache as the second- highest cause of disability worldwide.

Because most headache data in GBD are from adults, leading to underestimation of headache-attributed burden, a global schools-based programme within the Global Campaign against Headache is contributing data from children (7–11 years) and adolescents (12–17 years).

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Gender- and age-adjusted 1-year prevalence of headache was 72.8% (migraine: 38.6%; tension-type headache: 19.9%; UdH: 12.3%; all headache on ≥15 days/ month: 1.2%; probable medication-overuse headache: 0.2%).

Headache was more prevalent in females (76.2%) than males (71.0%), a finding

reflected only in migraine among the headache types.

Headache was more prevalent among adolescents (77.6%) than children (68.4%), reflected in all types except migraine, although prevalence of UdH fell sharply after age 14 years to 3.9%.

For headache overall, findings matched those in Turkey and Austria, obtained with the same questionnaire, but the high prevalence of migraine, not increasing with age, was surprising.

The study highlighted diagnostic difficulties in young people, especially when poorly educated, with migraine diagnoses driven by improbably high proportions reporting nausea (44.8%) and vomiting (28.0%) as usual symptoms accompanying their headaches.

Headache is very common in children and adolescents in Ethiopia. Extended: Headache is very common in children and adolescents in Ethiopia— apparently more so than in adults—a finding with major public-health implications for a country in which half the population are aged under 18 years [30].

Introduction Over multiple iterations between 2000 and 2019, the Global Burden of Disease (GBD) study has demonstrated that headache disorders are a major cause of global ill health, to the extent of being the second highest cause of disability [8–35].

A key objective of the Global Campaign against Headache, under the direction of Lifting The Burden (LTB), is to quantify headache-attributed burden worldwide [36–39].

In children (aged 6–11 years) and adolescents (12–17 years), the same are impor- tant, but recent studies have shown, in addition, a prevalent headache disorder char- acterised by mild pain of short duration (<1 h) [40, 41].

While no published data exist for child and adolescent headache in this country, a population-based national survey on adult headache disorders showed that they were common: 1-year prevalence estimates were 17.7% for migraine (higher than the global mean [35]), 20.6% for TTH, 0.7% for probable MOH (pMOH) and 2.5% for other headache on ≥15 days/month [42].

This study estimated the prevalence and attributed burden of headache disorders

in children and adolescents in Ethiopia.

Methods Enquiry was by self-completed questionnaire administered under supervision to pupils within their school classes.

Information sheets describing the nature and purposes of the survey, and consent forms, were distributed to pupils in the participating schools on the day preceding the survey, and prior consent obtained from or on behalf of each participating child or adolescent (in most sites, teachers signed to signify the consent of children rather than the children themselves, in accordance with the terms of ethics approval).

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Epidemiology

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In each school, all classes including pupils aged 6–11 years and/or 12–17 years

were invited to participate.

Pupils who happened to be absent from school on the survey day were not part

of the sample, and not, therefore, counted as non-participants.

Results Adjusted 1-year prevalence estimates were 72.8% for all headache, 38.6% for migraine, 19.9% for TTH, 12.3% for UdH and 1.2% for all headache on ≥15 days/month.

HY was reported by 630 (36.5%) of 1725 participants with headache (one did

not respond to this question).

Adolescents reported only marginally more HY than children, although a year- by- year analysis showed a substantial increase (to 42–44%) in those aged 15–17 years (OR: 1.8 [1.4–2.3]; p < 0.001).

Headache on ≥15 days/month was, as anticipated, the greatest contributor to HY proportionately (by definition, > 50% was expected), but its overall impact was limited by its relatively low prevalence.

This discrepancy was evident in migraine, TTH and UdH, but, for headache on

≥15 days/month, HY was approximately matched by both predictions. Discussion Although we are not presenting headache duration here, reported duration for 64.9% of all headache, including 84.4% of cases diagnosed as probable migraine, was <2 h. In relation to this, we must question our finding of 38.6% migraine prevalence, which we acknowledge to be implausible.

LTB’s study of adult headache disorders in Ethiopia estimated 1-year prevalence

of migraine at 17.7% (with rather more TTH, at 20.6%) [42].

In children in particular, headache diagnosis is notoriously difficult, dependent as it is on comprehension of language on the one hand (formulation of ICHD crite- ria into questions that are clear and unambiguous to children is a challenge) and subjective evaluations on the other (over a quarter [26.5%] of cases with reported headache duration of <1  h were diagnosed as probable migraine, the distinction from UdH resting solely on reported headache intensity).

Conclusions Headache is very common in children and adolescents in Ethiopia—apparently more so than in adults—a finding with major public-health implications for a coun- try in which half the population are aged under 18 years [30].

With no similar study yet from elsewhere in the whole of SSA, or from another low-income country, this finding also contributes to knowledge and understanding of child and adolescent headache globally.

Acknowledgement A machine generated summary based on the work of Zewde, Yared Zenebe; Zebenigus, Mehila; Demissie, Hanna; Tekle-Haimanot, Redda; Uluduz, Derya; Şaşmaz, Tayyar; Bozdag, Fatma; Steiner, Timothy J. 2020  in The Journal of Headache and Pain.

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The prevalence of headache disorders in children and adolescents in Mongolia: a nationwide schools-based study