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

DOI: https://doi.org/10.1186/s10194- 020- 01175- 6

Abstract-Summary The Global Campaign against Headache collects data from children (7–11 years) and adolescents (12–17 years) both to inform health and education policies and to contribute to the Global Burden of Disease (GBD) study.

This survey in Mongolia was part of this global enquiry. Observed lifetime prevalence of headache was 81.0%. Gender- and age-adjusted 1-year prevalence was 59.4% (migraine: 27.3%; tension- type headache [TTH]: 16.1%; UdH: 6.6%; all headache on ≥15 days/month: 4.2%; probable medication-overuse headache: 0.7%).

All headache types except UdH were more prevalent among females than males, and all were more prevalent among adolescents than children, although UdH repre- sented a higher proportion of all headache in children (13.0%) than in adolescents (10.0%).

At least in adolescents, headache in Mongolia is no less common than in adults. The clear difference from similar studies in other countries was a lower preva- lence of UdH, perhaps a consequence of reporting bias in a non-troublesome head- ache (mild and short-lasting by definition).

This study informs policy in Mongolia and, with no similar study yet from else- where in Western Pacific Region, makes an important contribution to the global enquiry.

Extended: At least in adolescents, headache is no less common than it is in adults

in Mongolia, nor in this age group than in other countries.

Introduction Studies in children and adolescents have been relatively few, with the prevalence of headache disorders much less well measured.

LTB, in collaboration with the International Headache Society (IHS), is now undertaking a global programme of schools-based studies using a standardised pro- tocol [43] to collect data from children aged 6–11  years and adolescents aged 12–17 years in countries in all world regions.

The study focuses on the headache disorders with public-health importance. As adding to knowledge and understanding of the global burden of headache, an

important purpose of this study is to inform local health and educational policies.

Methods We followed the generic protocol for the global programme [43], conducting a cross-sectional survey in schools selected to be nationally representative.

A structured questionnaire was completed by pupils under supervision within

their school classes.

1.1

Epidemiology

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Information sheets describing the nature and purposes of the survey were distrib-

uted to pupils in the participating schools to take home to parents or guardians.

Pupils who were absent from school on the survey day were not counted as non-

participants since they were not available for inclusion.

We categorized schools by their locality (urban, semi-rural or rural), by pupils’ home income (teachers’ estimates of the proportions of pupils coming from low- income homes: less than one quarter [“higher income”], one quarter to one half [“middle income”] or more than half [“lower income”]), and by home proximity (teachers’ estimates of the proportions of pupils travelling for ≥1 h/day to attend: less than one quarter [“mostly close”] or more than one quarter [“many distant”]).

Results Headache ever was reported by 3456 participants (observed lifetime prevalence: 81.0%; 95% CI: 79.8–82.2%).

Nausea and vomiting, both specific to migraine, were reported by 48.8% and

14.5% respectively of participants with headache.

HY was reported by 679 participants, 26.0% of 2614 with headache (three did

not respond to this question) and 15.9% of the total sample.

Females (30.3%) reported HY substantially more than males (20.7%; p < 0.001),

but adolescents (27.0%) only marginally more than children (24.3%; p > 0.05).

Headache on ≥15 days/month, including pMOH, was, proportionately, by far the greatest contributor to HY (≥70%), which was expected since, by definition in these disorders, it must be >50%.

For pMOH, HY was closely matched by both predictions; for other headache on

≥15 days/month, predictions were reasonably approximated. Discussion As similar studies have found in European [40, 44] and African Regions [45], head- ache had been experienced by most of these young participants (reported lifetime prevalence 81.0%).

By the same token, the prevalence of UdH as a proportion of all reported head- ache is expected to decline with increasing age, as was seen in Turkey [40], Lithuania [44] and Austria [41], and as it did here, from 13.0% in children to 10.0% in adolescents.

Most telling in this study was a prevalence of headache on ≥15  days/month

of 10.7%.

While reported headache days in the preceding one and four weeks were per- fectly feasible for migraine, TTH and UdH, the 1-day prevalence estimates that these gave rise to predicted less HY for each of these than was actually reported (by factors of 1.25–1.5 and about 2 for the 1-week and 4-week estimates respectively).

Conclusions The findings of this study are available to inform educational and health policies in Mongolia.

With no similar study yet from elsewhere in the whole of Western Pacific Region, they also make an important contribution to LTB’s global enquiry into child and

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1 Public Health

adolescent headache, a major fact-finding component of the Global Campaign against Headache [36, 37].

Acknowledgement A machine generated summary based on the work of Luvsannorov, Otgonbayar; Anisbayar, Tsengunmaa; Davaasuren, Munkhzul; Baatar, Otgonzaya; Batmagnai, Khaliunaa; Tumurbaatar, Khulan; Enkhbaatar, Sarantuya; Uluduz, Derya; Şaşmaz, Tayyar; Solmaz, Elif Tuğçe; Steiner, Timothy J. 2020 in The Journal of Headache and Pain.

Primary headache disorders among the adult population of Mongolia: prevalences and associations from a population-based survey