Prevalence of headache among children and adolescents in Shanghai, China

Correlation between benign joint hypermobility syndrome and headache in children and adolescents

BACKGROUND

Benign Joint Hypermobility Syndrome (BJHS) is a most common hereditary connective tissue disorders in children and adolescents. This study aimed to investigate the prevalence and subtypes of headache in children with BJHS.

METHODS

This observational-analytical study was conducted in a case-control setting on school children aged 7 to 16 years in 2021-2023 in Isfahan, Iran. Students were examined for BJHS using Beighton criteria by a pediatric rheumatologist. Headache disorder was diagnosed according to the Child Headache-Attributed Restriction, Disability, and Social Handicap and Impaired Participation (HARDSHIP) questionnaires for child and adolescent and International Classification of Headache Disorders (ICHD-III).

RESULTS

A total of 4,832 student (mean age 10.3 ± 3.1 years), 798 patients with BJHS and 912 healthy children were evaluated. The probability of headache in children aged 7-11 with hypermobility was 3.7 times lower than in children aged 12-16 with hypermobility (P = 0.001). The occurrence of headache in children with BJHS was more than the control group (P = 0.001), and the probability of headache in children with BJHS was 3.7 times higher than in healthy children (P = 0.001). Migraine was the most common headache type reported of total cases. The probability of migraine in children with BJHS was 4.5 times higher than healthy children ( P = 0.001).

CONCLUSION

This study showed a significant correlation between BJHS and headache (especially migraine) in children and adolescents.

Secular Trends in the Incidence of Migraine in China from 1990 to 2019: A Joinpoint and Age–Period–Cohort Analysis

Background

Migraine is a common disorder of the nervous system in China, imposing heavy burdens on individual and societies. Optimal healthcare planning requires understanding the magnitude and changing the trend of migraine incidence in China. However, the secular trend of migraine incidence in China remains unclear.

Methods

Data were collected from the Global Burden of Disease Study 2019 in China from 1990 to 2019 to investigate changes in the incidence rate of migraine. The average annual percent change and the relative risk were calculated using the joinpoint regression model and the age–period–cohort model, respectively.

Results

From 1990 to 2019, the age-standardized incidence rates of migraine in China increased by 0.26% (95% CI: 0.22 to 0.31) and 0.23% (95% CI: 0.19 to 0.28) per year in males and females, respectively. Age effects exerted the most significant impact on migraine incidence. Period effects showed a slightly decreasing trend in the incidence of migraine. In terms of cohort effects, people born after the 1960s presented a higher risk of migraine as compared with the total cohort, with the incidence risk of migraine increasing with birth cohorts.

Conclusion

Migraine incidence shows an overall increasing trend in China, with a significant gender difference. A comprehensive understanding of the risk characteristics and disease pattern of migraine could allow the early detection of persons with a high risk of developing migraine and promote the development of timely intervention measures to relieve this burden effectively.

Prevalence, burden, and clinical management of migraine in China, Japan, and South Korea: a comprehensive review of the literature

BACKGROUND

The objective of this review was to determine the unmet needs for migraine in East Asian adults and children.

METHODS

We searched MEDLINE and EMBASE (January 1, 1988 to January 14, 2019). Studies reporting the prevalence, humanistic and economic burden, and clinical management of migraine in China (including Hong Kong and Taiwan), Japan, and South Korea were included. Studies conducted before 1988 (before the International Headache Society [IHS] first edition of the International Classification of Headache Disorders) were not included.

RESULTS

We retrieved 1337 publications and 41 met the inclusion criteria (28 from China, 7 from Japan, and 6 from South Korea). The 1-year prevalence of migraine (IHS criteria) among adults ranged from 6.0% to 14.3%. Peak prevalence ranged from 11% to 20% for women and 3% to 8% for men (30- to 49-year-olds). For children, prevalence of migraine increased with age. Information on the economic burden and clinical management of migraine was limited, particularly for children. When reported, migraine was significantly associated with high levels of disability and negative effects on quality of life. Studies suggested low levels of disease awareness/diagnosis within each country. Of individuals with migraine from China, 52.9% to 68.6% had consulted a physician previously, 37.2% to 52.7% diagnosed with headache had not been diagnosed with migraine previously, and 13.5% to 18% had been diagnosed with migraine previously. Of individuals with migraine from Japan, 59.4% to 71.8% had never consulted a physician previously, 1.3% to 7.3% regularly consulted physicians for their headache, and only 11.6% of individuals with migraine were aware that they had migraine. In addition, studies suggested that over-the-counter medication use was high and prescription medication use was low in each country.

CONCLUSIONS

This review suggests that there are unmet needs for migraine in terms of sufficient and appropriate diagnosis, and better management and therapies for treatment of migraine in East Asia. The findings are limited by a lack of recent information and significant gaps in the literature. More recent, population-based studies assessing disease burden and clinical management of migraine are needed to confirm unmet needs for migraine across East Asia.

Prevalence and Burden of Primary Headache Disorders in Kuwaiti Children and Adolescents: A Community Based Study

Background/Objective: Primary headaches are common in the pediatric and adolescent population and can be disabling for them and their families. We aimed to assess the prevalence and burden of primary headache disorders among children and adolescents in Kuwait.

Methods: A cross-sectional community-based study included Kuwaiti population aged 6–17 years. They were randomly recruited from all six governorates of Kuwait using stratified multistage cluster sampling. The Headache-Attributed Restriction, Disability, and Social Handicap and Impaired Participation (HARDSHIP) questionnaire for children and adolescents was used to collect the data.

Results: Data were collected from 3,423 subjects; 664 subjects were diagnosed as having primary headache disorders. The mean age was 12.61 ± 2.51 years and 64.2% were females. One year prevalence of headache was 19.4%. It was significantly prevalent in females compared to males (25.2% vs. 13.8%; P < 0.001). Primary headache disorder significantly increased in age group 12–17 when compared to age group 6–11 years (25.8% vs. 10.4 %; p < 0.001). One year primary headache prevalence showed non-significant differences in both males and females in age group 6–11 years (10.1% in males vs. 10.6% in females; P < 0.79), while it was significantly higher in female vs. males (38.1% vs. 15.8%; P < 0.001) in age group 12–17 years. Migraine prevalence was 10.9% followed by tension type headache (TTH) 6.2% and chronic headache 0.9%. Medical care utilization was reported in 67% of our cohort. The majority (95%) of the patients received symptomatic drugs for headache attacks and only 7.5% used preventive medication. The students with headache lost a mean of 1.29 ± 1.23 days of school, reported mean of 1.16 ± 1.50 days they could not do activities they had wanted to. Their parents lost a mean of 1.01 ± 1.02 days of work because of headaches of their children during the preceding 4 weeks of the study.

Conclusions: The estimated 1 year prevalence of headache was 19.4% overall. Primary headache prevalence increased with age and it was more prevalent in female adolescents compared to males of the same age. Headache disorders in children/adolescents affect school and social activities as well as their parents work. The awareness for early diagnosis and preventive medications for headache in this age group may reduce the headache burden.

Pediatric and Adolescent Headache

PURPOSE OF REVIEW

This article provides the practicing neurologist with a comprehensive, evidence-based approach to the diagnosis and management of headache in children and adolescents, with a focus on migraine.

RECENT FINDINGS

Four triptans are now labeled by the US Food and Drug Administration (FDA) for acute migraine treatment in adolescents, and rizatriptan is labeled for use in children age 6 and older. For preventive migraine treatment, the Childhood and Adolescent Migraine Prevention trial demonstrated that approximately 60% of children and adolescents with migraine will improve with a three-pronged treatment approach that includes: (1) lifestyle management counseling (on sleep, exercise, hydration, caffeine, and avoidance of meal skipping); (2) optimally dosed acute therapy, specifically nonsteroidal anti-inflammatory drugs and triptans; and (3) a preventive treatment that has some evidence for efficacy. For the remaining 40% of children and adolescents, and for those who would not have qualified for the Childhood and Adolescent Migraine Prevention trial because of having continuous headache or medication-overuse headache, the clinician's judgment remains the best guide to preventive therapy selection.

SUMMARY

Randomized placebo-controlled trials have been conducted to guide first-line acute and preventive migraine treatments in children and adolescents. Future research is needed to guide treatment for those with more refractory migraine, as well as for children and adolescents who have other primary headache disorders.

Prevalence of headache and its interference in the activities of daily living in female adolescent students

OBJECTIVE:

To describe the prevalence of headache and its interference in the activities of daily living (ADL) in female adolescent students.

METHODS:

This descriptive cross-sectional study enrolled 228 female adolescents from a public school in the city of Petrolina, Pernambuco, Northeast Brazil, aged ten to 19 years. A self-administered structured questionnaire about socio-demographic characteristics, occurrence of headache and its characteristics was employed. Headaches were classified according to the International Headache Society criteria. The chi-square test was used to verify possible associations, being significant p<0.05.

RESULTS:

After the exclusion of 24 questionnaires that did not met the inclusion criteria, 204 questionnaires were analyzed. The mean age of the adolescents was 14.0±1.4 years. The prevalence of headache was 87.7%. Of the adolescents with headache, 0.5% presented migraine without pure menstrual aura; 6.7%, migraine without aura related to menstruation; 1.6%, non-menstrual migraine without aura; 11.7%, tension-type headache and 79.3%, other headaches. Significant associations were found between pain intensity and the following variables: absenteeism (p=0.001); interference in ADL (p<0.001); medication use (p<0.001); age (p=0.045) and seek for medical care (p<0.022).

CONCLUSIONS:

The prevalence of headache in female adolescents observed in this study was high, with a negative impact in ADL and school attendance.

Study of various social and demographic variables associated with primary headache disorders in 500 school-going children of central India

Objectives:

This study was performed to know the prevalence of primary headache disorders in school going children of central India and to elucidate the effects of various sociodemographic variables like personality or behavior traits, hobbies like TV watching, school life or study pressure in form of school tests, family history of headache, age, sex, body habitus etc., on prevalence of primary headaches in school going children of central India.

Materials and Methods:

A cross-sectional school-based study was performed on 500 school children (aged 7–14 years) for the duration of 1 year. Potential triggering and aggravating demographic and social variables were investigated based on a diagnosis of International Classification of Headache Disorder-II headache.

Results:

The prevalence of recurrent headache was found to be 25.5% in Indore. Of the studied population, 15.5% had migraine, 5% had tension-type headache migraine, and 5% had mixed-type headache symptoms suggesting both of above. Overall headaches were found to be more common among girls, but tension-type was more common in boys. Using regression analysis, we found that sensitive personality traits (especially vulnerable children), increasing age, female gender and family history of headache had a statistically significant effect on headaches in children. In addition, mathematic or science test dates and post weekend days in school were found to increase the occurrence of headache in school-going children. Hobbies were found to have a significant effects on headaches.

Conclusion:

As a common healthcare problem, headache is prevalent among school children. Various sociodemographic factors are known to trigger or aggravate primary headache disorders of school children. Lifestyle-coping strategies are essential for school children.

Headache care in China

Headache disorders are problematic worldwide. China is no different. A population-based door-to-door survey revealed that the 1-year prevalence of primary headache disorders in China was 23.8%, constituting a major societal burden. Many headache centers and clinics have been established in China, and headache disorders (and associated stress) are receiving an increased level of expert attention. This review summarizes the outcomes of the epidemiological survey and the progress of clinical and basic research in China, describes the present situation in terms of headache diagnosis and treatment, and discusses the future of headache care in China.

Contributions of epidemiology to our understanding of migraine

BACKGROUND

During the past decade, the introduction of the second edition of the International Classification of Headache Disorders (ICHD-II) and the initiation of active campaigns to increase awareness of the high magnitude, burden, and impact of migraine have stimulated numerous studies of population-based data on the prevalence, correlates, and impact of migraine.

OBJECTIVE

This paper provides an update of the literature on the worldwide epidemiology of migraine from studies that included the ICHD-II criteria. The aims of this paper are: (1) to review evidence regarding the magnitude of migraine; (2) to summarize information on the correlates and impact of migraine; and (3) to discuss the contributions, challenges, and future directions in the epidemiology of migraine. Evidence on the magnitude of migraine is divided into the following types of data: (1) prevalence rates of ICHD-II-defined migraine and tension-type headache from international population-based studies of adults; (2) the magnitude of migraine in U.S. studies; (3) ICHD-II-based international prevalence rates of ICHD-II-defined migraine in children; and (4) incidence rates of migraine from prospective longitudinal studies.

METHODS

A comprehensive review of the literature on the prevalence of migraine subtypes and tension-type headache defined by ICHD-II criteria during the past decade was conducted and aggregate weighted rates across studies were derived.

RESULTS

Across the 19 studies of adults that employed the ICHD-II criteria, the aggregate weighted estimates of the 12-month prevalence of definite migraine are 11.5%, and probable migraine of 7%, yielding a total of 18.5%. The cross-study weighted aggregate rate of migraine with aura is 4.4%, chronic migraine is 0.5%, and of tension-type headache is 13%. There has been even greater growth in international prevalence data on migraine in children, with a total of 21 studies of children that have employed the ICDH-II criteria. The aggregate weighted rate of definite migraine in children is 10.1% and migraine with aura is 1.6%. The well-established demographic correlates of migraine including the equal sex ratio in childhood, with increasing prevalence of migraine in females across adolescence to mid-adulthood were confirmed in these studies. Despite increasing effort to increase awareness of migraine, approximately 50% of those with frequent and/or severe migraine do not receive professional treatment.

CONCLUSIONS

This review demonstrates that the descriptive epidemiology of migraine has reached its maturity. The prevalence rates and sociodemographic correlates have been stable across 50 years. These developments justify a shift in efforts to the application of the designs and methods of analytic epidemiology. Retrospective case-control studies followed by prospective cohort studies that test specific associations are likely to enhance our understanding of the predictors of incidence and progression of migraine, subtypes of migraine with differential patterns of onset and course, and specific environmental exposures that may have either causal or provocative influences on migraine etiology.