Abstract
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.
Highlights
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
The most common diagnosis was undifferentiated headache” (UdH) (26.1%; 26.5% in girls, 25.5% in boys; 34.5% of those with any headache). This was followed by migraine (24.2%; 28.1% in girls, 19.5% in boys; 32.6% of those with headache) and tensiontype headache (TTH) (21.6%; 22.4% in girls, 20.7% in boys; 28.5% of those with headache) (Table 2)
The drivers were migraine in girls and TTH in both genders, the overall increase was partially offset by a decrease in UdH in girls but not boys (Table 2)
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 hour. With published adult prevalences of 46–79% for any headache, 38–42% for tensiontype headache (TTH), 11–35% for migraine, 3–7.2% for headache on ≥15 days/month (H15+) and 3.1% for probable medication-overuse headache (pMOH) [4, 5], these disorders are a major public-health problem worldwide, associated with impaired health-related quality of life (HrQoL) and high personal impact [5, 6]. Headache disorders have the added and adverse potential of disrupting education [7], imposing a burden likely to be expressed throughout life [8]. HrQoL was poorer in pupils with headache than in those without [7, 9]
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