2967 Australian headache epidemiology data (AHEAD): a pilot study

BackgroundThere are no robust population-based Australian data on prevalence and attributed burden of migraine and medication-overuse headache (MOH) data. In this pilot cross-sectional study, we aimed to capture the participation rate, preferred response method, and acceptability of self-report questionnaires to inform the conduct of a future nationwide migraine/MOH epidemiological study.MethodsWe developed a self-report questionnaire, available in hard-copy and online, including modules from the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire, the Eq. 5D (quality of life), and enquiry into treatment gaps. Study invitations were mailed to 20,000 randomly selected households across Australia’s two most populous states. The household member who most recently had a birthday and was aged ≥ 18 years was invited to participate, and could do so by returning a hard-copy questionnaire via reply-paid mail, or by entering responses directly into an online platform.ResultsThe participation rate was 5.0% (N = 1,000). Participants’ median age was 60 years (IQR 44–71 years), and 64.7% (n = 647) were female. Significantly more responses were received from areas with relatively older populations and middle-level socioeconomic status. Hard copy was the more commonly chosen response method (n = 736). Females and younger respondents were significantly more likely to respond online than via hard-copy.ConclusionsThis pilot study indicates that alternative methodology is needed to achieve satisfactory engagement in a future nationwide migraine/MOH epidemiological study, for example through inclusion of migraine screening questions in well-resourced, interview-based national health surveys that are conducted regularly by government agencies. Meanwhile, additional future research directions include defining and addressing treatment gaps to improve migraine awareness, and minimise under-diagnosis and under-treatment.

BackgroundRecent studies indicate that migraine affects 14–15% of the global population, tension-type headache (TTH) around 26%, and medication-overuse headache (MOH) 1–2%. While these estimates highlight the impact of these conditions on population health, their reliability is compromised by the variable quality of contributing studies. In response, the Global Campaign against Headache has supported epidemiological studies in all parts of the world, using standardized methods.MethodsWe conducted a meta-analysis of individual participant data from these studies, accepting only population-representative data (17 countries from all world regions). All included studies were cross-sectional surveys of adults aged 18–65 years using the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire. Algorithmic diagnosis applying modified International Classification of Headache Disorders (ICHD) criteria identified the headache disorders of public-health importance: migraine, TTH and probable MOH (pMOH: the association of headache on ≥ 15 days/month [H15+] and reported medication overuse). Two sets of estimates were made for migraine and TTH, one excluding those with H15+ (standard process), the other including these (extended process). We analysed associations with demographical variables, and, accordingly, adjusted prevalence estimates for age, gender and country income level.ResultsWe included 41,614 individuals, with over-representations of females (22,278 [53.5%]) and of participants from lower-middle income countries (59.7%; global 37.8%). Age-distribution was similar to that of the world. Overall, 65.5% (95% CI: 65.0–66.0) reported headache during the previous year, females (72.1% [71.5–72.7]) more than males (57.9% [57.2–58.6]). Migraine was more common among females (standard process: 29.5% [28.9–30.1]; extended process: 33.1% [32.5–33.7]) than males (18.6% [18.1–19.2]; 20.1% [19.6–20.7]), as was pMOH (5.6% [5.3–5.9] vs. 2.3% [2.1–2.5]). TTH was similarly prevalent among males (33.4% [32.8–34.1]; 34.9% [34.2–35.5]) and females (31.2% [30.6–31.8]; 33.2% [32.6–33.8]). Headache was more prevalent in high/upper-middle income countries (71.4% [70.6–72.2]) than in low/lower-middle income (63.0% [62.5–63.6]). Prevalence estimates adjusted for age, gender and income level were 65.0% (64.6–65.5) for any headache, 23.5% (23.1–23.9; standard process) and 25.9% (25.4–26.3; extended process) for migraine, 33.2% (32.7–33.6) and 34.7% (34.3–35.2) for TTH, and 4.1% (3.9–4.3) for pMOH.ConclusionsAbout 65% of the world’s population aged 18–65, likely to include most of the world’s workforce, will have headache during the coming year, about 25% migraine and 4% pMOH. Both these estimates are higher than previous comparable estimates, and we believe them to be the best currently available for this population. Our estimate of TTH prevalence (about 33%) is probably substantially too low, since methodological constraints precluded identification of TTH in those with concomitant migraine.Supplementary InformationThe online version contains supplementary material available at 10.1186/s10194-025-02142-9.

Headaches affect people's social, intellectual, and personal lives and are quite common worldwide, especially among young adults. Primary headaches that cause significant impairment, such as tension-type headaches (TTH) and migraines, frequently start in adolescence and early adulthood. Research on the incidence and consequences of headache problems among young people in India is scarce, especially when it comes to a variety of academic fields. This study aims to 1) estimate the prevalence and types of headaches among young adults aged 18-24 years and 2) identify common triggers and assess the social and academic impact of headache disorders. Young adults from different academic backgroundsin Chennai, South India, participated in this cross-sectional survey during September and October of 2024. A total of 438 participants across the Medical, Engineering, Dental, and Arts and Science disciplines were reached via snowball sampling. The study utilized a questionnairebased on Headache-Attributed Restriction, Disability, Social Handicap, and Impaired Participation to gather data on demographics, headache types, triggers, and their impact using Google Forms. Statistical Product and Service Solutions version 21 (IBM Corp., Armonk, NY) was used for the statistical analysis, and associations were evaluated using the chi-square and analysis of variance tests. The average age of the 438 participants was 20.1 years. Of the 438 respondents, 60.9% (267 subjects) reported having headaches in the last 12 months, with 54.6% reporting headaches in the last 30 days. Among those with headache disorders (267 subjects), 35% were diagnosed with TTH, 26% with migraine, and the remaining 39% had other types of headache. Compared with TTH and other headaches, migraines were linked to greater rates of academic interference, interruption of leisure activities, and absenteeism. In addition, migraineursreported greater levels of social avoidance (46.3%) and a substantial family history (31.6%) compared to other headache disorders. The most often stated trigger was personal stress (38.7%), which was followed by academic stress, sinusitis, and sleep difficulties. Headaches affect social life, everyday activities, and academic performance in young adults. They are highly prevalent and bothersome issues. More severe impairment seems to result from migraines than from TTH. To enhance the treatment of headache problems in this group, it is imperative to raise awareness, encourage early intervention, and remove obstacles to accessing healthcare.

BackgroundThere is a lack of up-to-date information on the prevalence and burden of headache in Norway. Here we describe the methods and validation of the diagnostic tool of the PopHEAD study, a study designed to determine the prevalence and burden of migraine, tension-type headache, and medication-overuse headache.MethodPopHEAD is a Norwegian population-based cross-sectional study conducted in Vestfold and Telemark County in 2023. A random sample of 28,753 individuals aged 18 to 70 was invited to participate. The study used a digital version of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire, translated into Norwegian using the Lifting The Burden translation protocol. A subsample of participants was contacted by telephone within four weeks for an interview with a headache neurologist blinded to the questionnaire responses. Headache disorders were diagnosed according to the criteria of the International Classification of Headache Disorders version 3. Validity was expressed by sensitivity, specificity and Cohen’s kappa (κ).ResultsIn total, 8,265 (3,344 men and 4,921 women) responded. Most men (75.0%) and women (89.7%) reported having had a headache in the past year. Of 667 participants contacted for a telephone interview, 505 responded. The sensitivity and specificity of the questionnaire-based diagnoses were 97% and 72% for self-reported headache in the previous year (Cohen’s kappa κ = 0.72), 77% and 85% for migraine (κ = 0.61), 77% and 74% for tension-type headache (κ = 0.51), and 58% and 99% for medication-overuse headache (κ = 0.63), respectively.ConclusionThe PopHEAD questionnaire is a valid tool for identifying individuals with lifetime headache, migraine, tension-type headache, and medication overuse headache.

Background: Primary headaches are remarkably prevalent worldwide and are increasingly reported among children. However, the exact trend in this age group, particularly in the Gulf region, remains largely unknown.Aims and Objectives: To examine the prevalence of primary headache disorders among primary and middle school students in Kuwait.Methods: We conducted a cross-sectional study that included Kuwaiti primary and middle school children and adolescents of both genders in randomly selected schools located in two governorates in Kuwait in the 2018/2019 academic year. Prevalence and attributable burden of headaches, definite and probable migraines, definite and probable tension-type headaches, chronic headaches (≥15 days/month), and probable medication-overuse headaches were assessed using the Headache-Attributed Restriction, Disability, Social Handicap, and Impaired Participation (HARDSHIP) questionnaire for children and adolescents.Results: Of 1,485 questionnaires that were distributed, 1,089 students completed the questionnaire with a respondent rate of 73.4%. The study population consisted of 420 boys (38.56%) and 669 girls (61.43%) students with a mean age of 11.5 ± 2.11 years. The 1-year prevalence of primary headache disorders was 42.78%, with more middle schoolers reporting headaches than primary schoolers (50.37 vs. 30.48%; p < 0.02). The mean age of students with primary headaches was 11.98 ± 2.03 years in both genders. When stratified according to diagnostic criteria, migraine headaches were the most frequently reported (20.75%), followed by tension type headaches (18.8%), chronic headaches (2.75%), and probable medication-overuse headaches (0.46%). Primary headaches were significantly higher in girls compared to boys among middle schoolers (66.46 vs. 38.49%; p < 0.001); however, no significant difference between genders was noted among primary school students (33.12 vs. 22.33%; p < 0.118).Conclusion: Primary headaches are remarkably common in Kuwaiti school students, with migraine headaches being the most frequently reported type. Age and female gender may play a role in the development of primary headaches. These findings necessitate the direction of health services and research efforts toward this age group and warrant the need for further epidemiological studies.

Background: The prevalence of primary headaches in the pediatric population is shaped by many factors, of which pubertal status may possibly play a substantial role. Epidemiological studies in the pediatric population in the gulf region remain scarce.Aims and objectives: To examine the impact of puberty on the prevalence of primary headache disorders among female schoolchildren in Kuwait.Methods: We conducted a cross-sectional study that included Kuwaiti primary and middle schoolgirls in randomly selected schools located in two governorates in Kuwait during the academic year 2018/2019. Prevalence of headache was assessed using the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire for children and adolescents. Female students were asked about their menarchal status and whether they attained menarche before or after experiencing headaches.Results: The questionnaire was completed by 669 girls with a mean age of 11.44 ± 2.14 years. The 1-year prevalence of migraine headache disorder among girls was 23.62%, and the lifetime prevalence of any headache was 84.9%, whereas the 1-year prevalence of primary headache disorders was 47.98%. The mean age of girls with headaches was 11.44 ± 2.14 years. With respect to diagnostic criteria, migraine headache was the most frequently reported (23.62%), followed by tension-type headaches (20.93%), chronic headaches (2.99%), and probable medication-overuse headaches (0.45%). Postpubertal females were at significantly higher risk of having primary headaches compared to their prepubertal counterparts (64.26 vs. 34%; p < 0.0001). All types of primary headaches were more significantly prevalent among postpubertal girls compared to those who are prepubertal.Conclusion: Migraine headache is commonly reported among Kuwaiti schoolgirls. Postpubertal females are at higher risk of developing primary headaches compared to prepubertal females. Pubertal transition and female sex hormones may play a significant role in the pathophysiology of headaches, migraines in particular, and further research is therefore needed to investigate the underlying mechanisms.

BackgroundHeadache disorders, particularly migraine and tension-type headache (TTH), are among the most prevalent global public-health problems. Medication-overuse headache (MOH) is a common sequela of mismanagement of these. Migraine and MOH are highly disabling. Formulation of responsive health policy requires reliable, locally-derived, population-based data describing both individual and societal impact of headache disorders. South-East Asia is the only one of WHO’s six world regions in which no such national data have yet been gathered.MethodsIn a nationwide population-based cross-sectional study, a representative sample of Nepalese-speaking adults (18–65 years) were randomly selected by stratified multistage cluster sampling. Trained interviewers made unannounced door-to-door visits and enquired into headache and its attributable burden using a culturally-adapted and validated Nepalese translation of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire.ResultsAmong 2100 participants, 1794 (85.4 %) reported headache during the preceding year (male: 689 [38.4 %], female 1105 [61.6 %]; mean age 36.1 ± 12.6 years). Mean headache frequency was 3.8 ± 6.2 days/month, mean headache intensity 2.1 ± 0.7 on a 0–3 scale, and mean attack duration 41.9 ± 108.5 h. All aspects of symptom burden (frequency, intensity and duration) were greater among females (p < 0.001). Participants with headache had poorer quality of life (QoL) than those without (p < 0.001); QoL was worst among those with probable MOH (pMOH).Mean proportions of total available time spent in the ictal state were 5.4 % among participants with migraine, 3.9 % among those with TTH and 44.7 % among those with pMOH, with headache-related disabilities of 2.4, 0.15 and 9.7 % respectively. At population level, these disorders were responsible for reduced functional capacities of 0.81, 0.06 and 0.20 %. Total lost productive time due to headache was 6.8 % for the 85 % of the population with headache. Males lost more paid worktime than females (p < 0.001); the reverse was so for household worktime (p < 0.001).ConclusionsHeadache disorders, very common in Nepal, are also highly burdensome at both individual and population levels. There is a substantial penalty in lost production. The remedy lies in better health care for headache; structured headache-care services are urgently needed in the country, and likely to be cost-saving.

The global burden of headache is very large, but knowledge of it is far from complete and needs still to be gathered. Published population-based studies have used variable methodology, which has influenced findings and made comparisons difficult. The Global Campaign against Headache is undertaking initiatives to improve and standardize methods in use for cross-sectional studies. One requirement is for a survey instrument with proven cross-cultural validity. This report describes the development of such an instrument. Two of the authors developed the initial version, which was used with adaptations in population-based studies in China, Ethiopia, India, Nepal, Pakistan, Russia, Saudi Arabia, Zambia and 10 countries in the European Union. The resultant evolution of this instrument was reviewed by an expert consensus group drawn from all world regions. The final output was the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire, designed for application by trained lay interviewers. HARDSHIP is a modular instrument incorporating demographic enquiry, diagnostic questions based on ICHD-3 beta criteria, and enquiries into each of the following as components of headache-attributed burden: symptom burden; health-care utilization; disability and productive time losses; impact on education, career and earnings; perception of control; interictal burden; overall individual burden; effects on relationships and family dynamics; effects on others, including household partner and children; quality of life; wellbeing; obesity as a comorbidity. HARDSHIP already has demonstrated validity and acceptability in multiple languages and cultures. Modules may be included or not, and others (eg, on additional comorbidities) added, according to the purpose of the study and resources (especially time) available.

Background: Headaches are a common disabling condition that affect many people worldwide. Headaches have been under-studied in developing countries and there is a paucity of literature documenting headaches in lecturers. The COVID-19 pandemic has forced lecturers to adapt to online teaching, which may have resulted in headaches. It is envisaged that this research will be beneficial to chiropractors, other healthcare providers and lecturers. Aim of Study: The aim of this study was to determine the prevalence, selected risk factors and burden of primary headaches in lecturers at a university of technology (UoT) in KwaZulu Natal during the COVID-19 pandemic. Methodology: A quantitative, descriptive cross-sectional design, where 685 lecturers employed at the Durban University of Technology, through self-selection, were selected to participate, using consecutive sampling. A minimum sample size of 247 was calculated, using a confidence level of 95% and confidence interval of 5%. Lecturers from all six faculties were invited to participate. The headache-attributed restriction, disability, social handicap and impaired participation (HARDSHIP) questionnaire was administered electronically via QUESTIONPRO®. Each participant was required to initial a consent form prior to answering the questionnaire. The diagnostic algorithm was utilised to diagnose headaches according to the diagnostic questions in the HARDSHIP questionnaire. All data were captured on an Excel spreadsheet and subsequently analysed using SPSS version 28. Results: There was a total of 255 completed questionnaires. The mean age of respondents was 45.66 years old. Of the total sample (n=255), 51.8% were headache sufferers. Most respondents suffered from probable tension-type headache (41.9%; n=54), followed by migraine-type headache (27.9%, n=36). Social risk factors revealed a significant relationship between alcohol and headaches, and sleep deprivation and headaches. Medial risk factors revealed a significant relationship between a head injury and headache and sinusitis and headache. Although there was a relationship between psychological risk factors and headache, it was not significant. Many work-related risk factors were significantly related to headache. There was a greater number of headache sufferers who tested positive for COVID-19. Many respondents experienced loneliness and their workload increased during the pandemic. Most of the respondents’ headaches interfered with work, and they usually took medication to treat their headache. Conclusion: Headaches are common in lecturing staff with, tension type headaches being most prevalent. There are many risk factors which are strongly associated with headaches and its impact caused an interference with work and negatively affected the suffers mental health. Family, social or leisure activities are also neglected when a headache occurred. This study adds to the current literature on headache prevalence in the lecturer population and increases awareness.

BackgroundHeadache disorders are highly prevalent worldwide, but not so well investigated in children and adolescents as in adults: few studies have included representative nationwide samples. No data exist for Austria until now. 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 hour.MethodsWithin the context of a broader national mental health survey, children and adolescents aged 10–18 years were recruited from purposively selected schools. Mediated self-completed questionnaires included sociodemographic enquiry (gender, age, socioeconomic status, family constellation, residence [urban or rural] and migration background). 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. Health-related quality of life (HrQoL) was assessed using the KIDSCREEN questionnaire.ResultsOf 7643 selected pupils, 3386 (44.3%) completed the questionnaires. 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. Attributable burden was high, with 42% of those with headache experiencing restrictions in daily activities. Medication use (50% overall) was highest in H15+ (67%) and still considerable in UdH (29%). 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). Participants with a migration background had a lower probability of TTH (OR 0.7, p < 0.01).ConclusionsHeadache 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 important diagnostic category of UdH. The findings call for action in national and international health policies, and for further epidemiological research.

BackgroundIndia is a large and populous country where reliable data on headache disorders are relatively scarce. This study in northern India (Delhi and National Capital Territory Region [NCR], including surrounding districts in the States of Haryana, Uttar Pradesh and Rajasthan) continues the series of population-based studies within the Global Campaign against Headache and follows an earlier study, using the same protocol and questionnaire, in the southern State of Karnataka.MethodsThis cross-sectional study used the Global Campaign’s established methodology. Biologically unrelated Indian nationals aged 18–65 years were included through multistage random sampling in both urban and rural areas of NCR. Interviews at unannounced household visits followed the structured Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire in its original English version or in the validated Hindi version. Demographic enquiry was followed by a neutral headache screening question and diagnostic questions based on the International Classification of Headache Disorders edition 3 (ICHD-3), which focused on each respondent’s most bothersome headache. Questions about headache yesterday (HY) enabled estimation of 1-day prevalence. A diagnostic algorithm first identified participants reporting headache on ≥ 15 days/month (H15+), diagnosing probable medication-overuse headache (pMOH) in those also reporting acute medication use on ≥ 15 days/month, and “other H15+” in those not. To all others, the algorithm applied ICHD-3 criteria in the order definite migraine, definite tension-type headache (TTH), probable migraine, probable TTH. Definite and probable diagnoses were combined.ResultsAdjusted for age, gender and habitation, 1-year prevalences were 26.3% for migraine, 34.1% for TTH, 3.0% for pMOH and 4.5% for other H15+. Female preponderance was seen in all headache types except TTH: migraine 35.7% vs. 15.1% (aOR = 3.3; p < 0.001); pMOH 4.3% vs. 0.7% (aOR = 5.1; p < 0.001); other H15 + 5.9% vs. 2.3% (aOR = 2.5; p = 0.08). One-day prevalence of (any) headache was 12.0%, based on reported HY. One-day prevalence predicted from 1-year prevalence and mean recalled headache frequency over 3 months was slightly lower (10.5%).ConclusionsThe prevalences of migraine and TTH in Delhi and NCR substantially exceed global means. They closely match those in the Karnataka study: migraine 25.2%, TTH 35.1%. We argue that these estimates can reasonably be extrapolated to all India.

BackgroundIn the ongoing Global Campaign endeavour to improve knowledge and awareness of headache prevalence worldwide, Mongolia is a country of interest. It sits between Russia and China, in which prevalence is, respectively, much higher and much lower than the estimated global mean. We conducted a population-based study in Mongolia both to add to knowledge and to inform local health policy.MethodsUsing standardized methodology with cluster random sampling, we selected Mongolian adults (aged 18–65 years) from five regions reflecting the country’s diversities. They were interviewed by trained researchers, cold-calling at their homes, using the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) structured questionnaire following pilot-testing. ICHD-3 beta diagnostic criteria were applied.ResultsN = 2043 (mean age 38.0 [±13.4] years, 40% urban-dwelling and 60% rural), with a non-participation proportion of 1.7%. Males were somewhat underrepresented, for which corrections were made. The crude 1-year prevalence of any headache was 66.1% (95% CI: 64.0–68.2%), with a strong female preponderance (OR: 2.2; p < 0.0001). Age- and gender-adjusted prevalences were: migraine 23.1% (for females, OR = 2.2; p < 0.0001); tension-type headache (TTH) 29.1% (no gender difference); probable medication-overuse headache (pMOH) 5.7% (trending towards higher in females); other headache on ≥15 days/month 5.0% (for females, OR = 2.2; p = 0.0008). Unclassified cases were only 35 (1.7%). Any headache yesterday was reported by 410 (20.1%; for females, OR = 2.4; p < 0.0001). Only pMOH showed a strong association with age, peaking in middle years with a 5-fold increase in prevalence. Migraine showed a consistent association with educational level, while pMOH showed the reverse, and was also more common among other groups than among participants who were single (never married). Migraine was less common among rural participants than urban (OR: 0.80; p = 0.0326), while pMOH again showed the reverse (OR: 2.4; p < 0.0001). Finally, pMOH (but not migraine or TTH) was significantly associated with obesity (OR: 1.8; p = 0.0214).ConclusionHeadache disorders are common in Mongolia, with, most notably, a very high prevalence of headache on ≥15 days/month corroborated by the high prevalence of headache yesterday. The picture is very like that in Russia, and dissimilar to China. There are messages for national health policy.

Reliable and up-to-date prevalence estimates of headache disorders are essential for public health planning. Despite previous large-scale studies, there is a lack of validated and up-to-date population-representative prevalence estimates from Europe. Here, we aimed to estimate the one-year prevalence of the major headache disorders in Norway using a validated diagnostic tool. PopHEAD is a population-based Norwegian cross-sectional study. A random sample of 28,753 individuals aged 18–70 years was invited to complete a digital version of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire, adapted and translated into Norwegian. Headache diagnoses were made using a standardized algorithm based on the International Classification of Headache Disorders (ICHD-3) criteria and validated by telephone interview in a sub-sample. Prevalence estimates were calculated as crude proportions with 95% confidence intervals and sequentially adjusted for age and sex, measurement error and selection bias. Associations with demographic variables were investigated. A total of 8,265 participants (3,344 men and 4,921 women; mean age 47.3 years) responded. The crude one-year prevalence was 29.6% for migraine (36.5% in women, 19.4% in men), 52.7% for tension-type headache (TTH) (51.4% in women, 54.6% in men), and 5.1% for probable medication-overuse headache (pMOH) (6.5% in women, 3.1% in men). After adjusting for age, sex, measurement error, and selection bias, the estimated prevalence was 20.3% for migraine, 47.9% for TTH, and 5.9% for pMOH. Migraine prevalence was highest among participants with low income and low education, while TTH prevalence was highest in participants with high socioeconomic status. pMOH prevalence was highest in participants aged 26–45 years and in participants with low education. The PopHEAD study provides updated, validated and bias-adjusted prevalence estimates for migraine, TTH and pMOH in the Norwegian adult population. These data may inform health resource allocation for headache management in similar populations.

Knowledge of headache among children (6-11 years) and adolescents (12-17 years) remains relatively sparse. This schools-based, cross-sectional survey in Nepal, in the series of similar studies conducted within the Global Campaign against Headache, was the first in South-East Asia Region. Our aims were to estimate the prevalence among these age groups of each of the headache disorders of public-health importance, and analyse their associations with demographic variables. The study followed the Global Campaign's standardized protocol. In schools selected to be representative of the country, the child and adolescent versions of the structured Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire were completed by pupils in class under supervision. Headache diagnoses followed ICHD-3, with the exception of undifferentiated headache (UdH), which, initially, we defined conventionally as mild headache lasting < 1h, then redefined as mild-to-moderate headache lasting < 1h. The diagnosis of UdH took precedence over diagnoses of migraine or tension type headache (TTH). Enquiry timeframes were 1 year and 4 weeks, with questions about headache yesterday (HY) included to circumvent recall error. Of 2,360 potential participants in nine schools, 2,352 completed the survey (1,040 children [44.2%]; 1,312 adolescents [55.8%]; participating proportion 99.7%). Males (54.0%) were slightly over-represented. The observed 1-year prevalence of any headache was 85.4% (males 83.5%; females 87.5%). Age- and gender-adjusted estimates were 82.4% for any headache, 39.9% for migraine, 30.3% for UdH (as redefined), 9.5% for TTH, 0.3% for probable medication-overuse headache (pMOH) and 2.0% for other headache on ≥ 15 days/month (H15+). Gender was not strongly associated with any headache type. UdH, TTH and other H15 + were more common among adolescents. Migraine was strongly and positively associated with altitude; the opposite was true for UdH. HY was reported by 20.7% of the sample (1-day prevalence), and by 24.3% of those with any headache (females [29.6%] more than males [19.5%]). The 24.3% was higher than predicted from headache frequency recalled over the preceding 1 week (17.6%) or 4 weeks (10.3%), indicating that participants, in recall, underestimated frequency. This study, complementing our adult study, showed that headache is highly prevalent also among children and adolescents in Nepal. As among adults, migraine was strongly and positively associated with altitude. The finding of less pMOH and other H15 + among these young people suggests opportunity to avert some of the headache-attributed burden among adults.

BackgroundThe large geographical gaps in our knowledge of the prevalence and burden of headache disorders include most of Eastern Mediterranean Region (EMR). Following a nationwide population-based study in Pakistan, we present here a similar study from Kingdom of Saudi Arabia (KSA). Both were conducted as projects within the Global Campaign against Headache The two purposes of this study were to inform national health policy and contribute to global knowledge of headache disorders.MethodsWe surveyed Arabic-speaking adults aged 18–65 years in all 13 regions of KSA. While previous Global Campaign studies have engaged participants by calling at randomly selected households, the culture of KSA made this unacceptable. Participants were, instead, contacted by cell-phone (since cell-phone coverage exceeded 100% in KSA), using random-digit dialling. Trained interviewers used a culturally adapted version of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire, with diagnostic enquiry based on ICHD-II. We estimated 1-year prevalences of the headache disorders of public-health importance (migraine, tension-type headache [TTH] and probable medication-overuse headache [pMOH]) and examined their associations with demographic variables.ResultsA total of 2316 participants (mean age of 32.2 ± 10.7 years; 62.3% male; 37.7% female) were included (participation proportion 86.5%). Gender and age distributions imperfectly matched those of the national population, requiring adjustments for these to prevalence estimates. Observed 1-year prevalence of all headache was 77.2%, reducing to 65.8% when adjusted. For headache types, adjusted 1-year prevalences were migraine 25.0%, TTH 34.1%, pMOH 2.0% and other headache on ≥15 days/month 2.3%. Adjusted 1-day prevalence of any headache was 11.5%. Migraine and pMOH were associated with female gender (ORs: 1.7 and 4.7; p < 0.0001). Migraine was negatively associated with age > 45 years (OR: 0.4; p = 0.0143) while pMOH was most prevalent in those aged 46–55 years (OR: 2.7; p = 0.0415). TTH reportedly became more common with increasing level of education.ConclusionPrevalences of migraine and TTH in KSA are considerably higher than global averages (which may be underestimated), and not very different from those in Pakistan. There is more pMOH in KSA than in Pakistan, reflecting, probably, its higher-income status and greater urbanisation (facilitating access to medication).