The burden attributable to headache disorders in children and adolescents in Lithuania: estimates from a national schools-based study

DOI: https://doi.org/10.1186/s10194- 021- 01237- 3

Abstract-Summary We recently showed headache to be common in children (aged 7–11 years) and adolescents (aged 12–17) in Lithuania.

We provide evidence from the same study of the headache-attributable burden. Questionnaires were completed by 2505 pupils (1382 children, 1123 adoles- cents; participating proportion 67.4%), of whom 1858 reported headache in the pre- ceding year, with mean frequency (±SD) of 3.7  ±  4.5 days/4 weeks and mean duration of 1.6 ± 1.9 h. Mean proportion of time in ictal state, estimated from these, was 0.9% (migraine 1.5%, probable medication-overuse headache [pMOH] 10.9%). Lost school time was 0.5  ±  1.5 days/4 weeks (migraine 0.7  ±  1.5, pMOH 5.0 ± 7.8) based on recall, but about 50% higher for migraine according to actual absences recorded in association with reported headache on the preceding day.

More days were reported with limited activity (overall 1.2  ±  2.4, migraine

1.5 ± 2.2, pMOH 8.4 ± 8.5) than lost from school.

Emotional impact and quality-of-life scores generally reflected other measures of burden, with pMOH causing greatest detriments, followed by migraine and tension- type headache, and UdH least.

Burdens were greater in adolescents than children as UdH differentiated into

adult headache types.

Headache in children and adolescents in Lithuania is mostly associated with

modest symptom burden.

The consequential burdens, in particular lost school days, are far from negligible for migraine (which is prevalent) and very heavy for pMOH (which, while uncom- mon in children, becomes four-fold more prevalent in adolescents).

Extended: Lost school time per affected pupil because of any headache averaged

0.5 days/4 weeks (ie, 0.5 days in 20 [2.5%], assuming a 5-day week).

Lost school time was greater for migraine than for TTH (p  <  0.01) or UdH (p < 0.001), while pMOH cost those affected one quarter (5/20) of their school days.

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1 Public Health

More days were reported with limited activity than were lost from school (nota-

bly, about one in every three for pMOH).

Emotional impact and QoL scores generally reflected other measures of burden. These findings are of importance not only to health policy but also to educational

policy in Lithuania.

Introduction In our recently published prevalence study, we showed headache to be common in children (aged 7–11 years) and adolescents (aged 12–17) in Lithuania [44], as we have with similar schools-based methodology in Turkey [40], Austria [41], Ethiopia [157] and Mongolia [158].

The prevalence study was part of a global enquiry into child and adolescent headache [43], an ongoing programme conducted by Lifting The Burden (LTB) [36–159] in its endeavour within the Global Campaign against Headache [36–38] to measure the scale and scope of headache-attributed burden worldwide.

From the public-health perspective, while disease prevalence determines the magnitude of disease-attributed burden in a population, it is not of itself very informative.

We present estimates of burden based on the prevalence findings [44] together with evidence of burden collected directly and contemporaneously from the same sample.

Methods The child and adolescent versions of LTB’s Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) structured questionnaire [43] were administered to the pupils in class, and completed under supervision.

Burden enquiry included symptom burden (frequency of headache, and its usual duration and intensity during episodes), symptomatic medication intake (fre- quency), lost time from schooling and other activities as well as lost parental work time (using adaptations of the Headache-Attributed Lost Time (HALT) index [160]), and selected (headache-relevant) questions from KINDL® [161] addressing con- centration, emotional impact and quality of life (QoL) [43]).

We expressed lost school time because of headache in days in the preceding 4 weeks, counting not going to school as a whole day and leaving school early as a half-day.

We counted participants reporting HY and the intensity of it, and those (as pro-

portions) reporting a lost school day because of HY.

We estimated predicted values of lost school yesterday as the product of number affected by headache and mean reported days (divided by 20) lost per pupil over the preceding 4 weeks.

Results Gender- and age-adjusted 1-year prevalence of any headache was 76.6%, of migraine 21.4%, of tension-type headache (TTH) 25.6%, of UdH 24.0%, of all headache on ≥15 days/month 3.9% and of probable medication-overuse headache (pMOH) 0.8%.

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Personal and Societal Burden

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Headache on ≥15 days/month (including pMOH) was, of course, more frequent than the episodic headaches but, among the latter, UdH was less frequent (p < 0.001) than migraine or TTH.

Participants with migraine and reporting HY were more likely to have lost school time yesterday than those with other headache types and reporting HY, but numbers were too few for significance (RR = 1.5 [0.9–2.3]; p = 0.1163).

Migraine, pMOH and other headache on ≥15 days/month were not significantly

different from each other, but all had greater impact (p < 0.001) than TTH.

Discussion For all headache types, more days were reported with limited activity than lost from school.

The 1.5  days/4  weeks (5.4%) reportedly affected in this way in those with migraine suggests a considerable life diminution, while the 8.4  days/4  weeks (almost 1 day in every three) reported by those with pMOH, and the 4.6 days (one in six) reported by the larger group with other headache on ≥15 days/month, are indicative of major life impairments.

The six questions contributing to this score related principally to concentration, mood, fear of headache and coping with it, so the gradient observed—pMOH hav- ing greatest impact, followed by other headache on ≥15 days/month, migraine and TTH, and UdH having significantly the least—was as expected.

Conclusions Headache, common in children and adolescents, is associated with symptom bur- dens that may not, for most, be onerous, but the consequential burdens, in particular lost school days, are not insubstantial.

These findings are of importance not only to health policy but also to educational

policy in Lithuania.

Acknowledgement A machine generated summary based on the work of Genc, Diana; Vaičienė- Magistris, Nerija; Zaborskis, Apolinaras; Şaşmaz, Tayyar; Tunç, Aylin Yeniocak; Uluduz, Derya; Wöber, Christian; Wöber-Bingöl, Çiçek; Steiner, Timothy J. 2021 in The Journal of Headache and Pain.

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