Prevalence and burden of headache in children and adolescents in Austria—a nationwide study in a representative sample of pupils aged 10–18 years

DOI: https://doi.org/10.1186/s10194- 019- 1050- 8

Abstract-Summary Headache disorders are highly prevalent worldwide, but not so well investigated in children and adolescents as in adults: few studies have included representative nationwide samples.

In a representative sample of children and adolescents in Austria, we estimated the prevalence and attributable burden of headache disorders, including the new diagnostic category of “undifferentiated headache” (UdH) defined as mild headache lasting less than 1 h.

Within the context of a broader national mental health survey, children and ado-

lescents aged 10–18 years were recruited from purposively selected schools.

Prevalence and attributable burden of all headache, UdH, migraine (definite plus probable), tension-type headache (TTH: definite plus probable) and headache on ≥15 days/month (H15+) were assessed using the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire for children and adolescents.

The 1-year prevalence of headache was 75.7%, increasing with age and higher in

girls (82.1%) than in boys (67.7%; p < 0.001).

UdH, migraine, TTH and H15+ were reported by 26.1%, 24.2%, 21.6% and

3.0% of participants.

HrQoL was reduced for all headache types except UdH. Participants in single parent or patchwork families had a higher probability of migraine (respectively, OR 1.5, p < 0.001; OR 1.5, p < 0.01).

Headache disorders are both very common and highly burdensome in children

and adolescents in Austria.

This study contributes to the global atlas of headache disorders in these age groups, and corroborates and adds knowledge of the new yet common and impor- tant diagnostic category of UdH. The findings call for action in national and inter- national health policies, and for further epidemiological research.

1.2

Personal and Societal Burden

77

Extended: Headache disorders are very common in children and adolescents in

Austria, as they are in other countries worldwide.

Background Two reviews have estimated the overall mean prevalence of headache in children and adolescents at 54.4–58.4%, with 7.7–9.1% migraine [216, 217].

While a few earlier epidemiological studies had reported unclassifiable head- aches, with an average prevalence of about 20% [40, 218, 219], most were silent on what appears to be a substantial proportion of affected children and adolescents.

The authors recommended inclusion of UdH in epidemiological studies not only to report the whole spectrum of headache disorders but also to give a full account of headache-attributed burden.

To redress this, and to contribute to the global atlas of headache disorders in children and adolescents, we performed this epidemiological study in a representa- tive national sample of children and adolescents in Austria.

This study assessed prevalence and burden of, and use of acute medication for,

headache overall and each of the common specific headache disorders.

Methods Burden questions referred to the numbers of days missed from school, leaving school early or with impaired everyday activities due to headache, within the previ- ous 4 weeks.

To participants reporting headache on <15  days/month we applied diagnostic criteria, in order, for definite migraine, definite TTH, probable migraine and prob- able TTH.

We enquired into gender, school grade, socioeconomic status (SES) of the fam-

ily, migration background, family constellation and place of residence.

Prevalence estimates (%) for any headache and for each headache type were

calculated for the total sample and for each gender and school grade.

In these regression models, all sociodemographic variables (gender, school grade, SES, family constellation, place of residence and migration background) were entered simultaneously, and only main effects were analyzed.

We analyzed impact of headache type on HrQoL, school attendance, school per- formance and everyday activities, as well as differences regarding medication use, using general linear models.

Results Some of these sociodemographic characteristics were more associated with specific headache types.

With regard to overall model fit, the sociodemographic characteristics included in the logistic regression models significantly predicted headache type (in all cases, p  <  0.001), whereas the explained variance was low (Nagelkerke R2  =  0.018 to 0.037).

Higher school grades were associated with migraine and TTH; older participants

had a higher probability of these headache types.

78

1 Public Health

During the preceding 4 weeks, 15.6% of participants with headache missed at least one whole school day because of headache, while 11.7% left school early at least once; 41.9% reported at least 1 day on which they were unable to do other activities they had wanted to.

HrQoL scores were reduced in participants with any headache compared with those with no headache on overall KIDSCREEN-10 score and on scores for self- perception, parent-relations and home life, and school environment (all p < 0.001).

Discussion Headache prevalence was higher than reported in earlier reviews [216, 217], but comparable to those from a nationwide study in Turkey also applying the Child and Adolescent HARDSHIP questionnaire (bearing in mind that the Turkish study included 6–18-year-olds) [40].

Although the proportions reporting missed daily activities, school days or les- sons were lowest in UdH compared with other headache types, they were still note- worthy (27%, 11%, 8%), clear evidence that the burden of headache is substantially underestimated if UdH is not included.

Among children and adolescents, headache prevalence has, with similar consis-

tency, been reported to increase with age [216, 218, 220, 221].

We found the same, overall and for all headache types except for H15+ and, of course, UdH. Children and adolescents with divorced parents and those living with a single parent have earlier reported higher prevalences of headache [222–224].

One study showed a correlation between migration background of the family and

prevalence of headache in children [225].

As UdH is expected to be an immature form of headache with a higher preva- lence in younger children, the prevalence of UdH might increase with the inclusion of younger children.

Conclusion Headache disorders are very common in children and adolescents in Austria, as they are in other countries worldwide.

This study confirms that UdH, a new diagnostic category, is very common in children and adolescents, while supporting the hypothesis that UdH may be a pre- cursor or immature form of migraine or TTH.

Our results contribute to the global atlas of headache disorders in children and adolescents, and reconfirm that headache disorders are highly relevant to health policy.

Acknowledgement A machine generated summary based on the work of Philipp, Julia; Zeiler, Michael; Wöber, Christian; Wagner, Gudrun; Karwautz, Andreas F. K.; Steiner, Timothy J.; Wöber-Bingöl, Çiçek. 2019 in The Journal of Headache and Pain.

1.2

Personal and Societal Burden

79

Migraine: a major debilitating chronic non-communicable disease in Brazil, evidence from two national surveys