Background

Headache is a very common health problem among adolescents, causing school and social disability [1]. This is the first Italian cross-sectional school-based study to use the new ICDH-3 beta classification system. The aim was to determinate the prevalence of headache and to investigate headache-related disability in a school-population aged 11-15.

Methods

Three hundred and seventy-six adolescents aged 11-15 years, living in the Pavia province (Italy), were recruited for this cross-sectional school-based study. They were assessed about their headache using a medical history questionnaire; headache diagnosis was made according to the new classification system of the International Headache Society (ICDH-3 Beta). Headache-related disability was assessed by means of PedMIDAS (Pediatric Migraine Disability Assessment Score).

Results

Of the 376 students enrolled 91 (24.2%) had headache: 60.44% girls (n=55) and 39.56% boys (n=36). At the first diagnosis, the prevalence of any migraine was 28.6% (n=26), any tension-type headache (TTH) 60.4% (n=55), any medication-overuse headache 3.3% (n=3) and “unclassifiable” headache was 7.7% (n=7) (Table 1). All types of chronic daily headache (CDH) and probable chronic daily headache (PCDH) were 23.07% (n=21) and 14.3% (n=13) of participants suffering from headache fulfilled criteria for more than one headache diagnosis (Table 2). No significant difference was found in PedMIDAS score between adolescents with migraine and those with TTH (p = 0.5074), neither between girls and boys (p = 0.961). More than half (53.84%, n=49) of headache types had a low PedMIDAS score, corresponding to no or low disability (Grade I), 25.27% (n=23) of adolescents had mild disability (Grade II), 6.6% (n=6) had moderate disability (Grade III) and 14.28% (n=13) had a severe disability (Grade IV) (Table 3). PedMIDAS score was highest in adolescents with chronic migraine (range from 13 to 176), but severe disability (Grade IV) was the same in chronic migraine (50%, 2 students of 4) and chronic TTH (50%, 7 students of 14). Of the 91 adolescents, only 4 (4.4%) were referred to the Headache Center of the Neuropsychiatric Clinic of Pavia, 1 was referred to an oculist and 5 were followed by a general practitioner, the others did not refer to anyone.

Table 1 Prevalence of ICDH-3 Beta headache disorders for the total sample and by sex.
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Table 2 Prevalence of ICDH-3 Beta headache disorders for the total sample: other types of headache.
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Table 3 Headache-related disability (PedMIDAS Score) by diagnosis.
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Conclusions

Headache is common in adolescents and can affect schoolwork and social activity. Thus, it is important to raise the awareness among general practitioners, families and teachers, so that they can identify headache in adolescents in its early stages and refer them for appropriate treatment.

Written informed consent to publish was obtained from the patient(s).

Conflict of interest

None declared.