The purpose of this study was to determine headache characteristics, impact on daily activities and medication attitudes among a large sample of adolescents in Italy.
Secondary school classes were randomly selected from a national stratified multistage sampling. Data regarding socio-familial factors, headache characteristics, impact on daily activities and medication use were recorded with an anonymous multiple-choice questionnaire.
The survey involved 2064 adolescents. 1950 questionnaires were considered for analysis. Study population included 944 males (48.4%) and 1006 females (51.6%), aged between 11 and 16 years (mean 13.5 ± 1.87). Headache prevalence was 65.9%. Mean age at headache onset was 8.33 years. 9.8% suffered from headache > 1/week, 14.3% > 1/month, 24.2% monthly and 17.7% less than monthly. The mean duration of a headache episode was less than 30 min in 32.9%, 1 hour in 28.1%, 2 hours in 19.3% and several hours in 19.5%. Pain intensity was moderate in 52.2% and severe in 9.5%. School represented the main trigger factor (67%). Impact on daily activities was noted in 57.5%. 69.2% of adolescents reported the use of pain relievers. Up to 5.7% declared self-medication, while only 20.6% followed a physician’s prescription. Female adolescents experienced headache more frequently (70.2% vs 60%) and more intensely than male peers. Girls had a higher family history of headache, could more frequently identify a trigger factor, and were more affected into their daily activities than boys.
Population-based studies of headache disorders are important, as they inform needs assessment and underpin service policy for a disease that is a public-health priority. Headache has a high prevalence among adolescents and carries a significant burden in terms of impact on daily activities and use of medication. Furthermore, underdiagnose is common, while trigger factors are often detectable. Special consideration should be given to female adolescents and self-medication attitudes.
Moschiano F, Messina P, D'Amico D, Grazzi L, Frediani F, Casucci G, et al. Headache, eating and sleeping behaviors and lifestyle factors in preadolescents and adolescents: preliminary results from an Italian population study. Neurol Sci. 2012;33:87–90. https://doi.org/10.1007/s10072-012-1048-3. CrossRef
Pogliani L, Spiri D, Penagini F, Di NF, Duca P, Zuccotti GV. Headache in children and adolescents aged 6-18 years in northern Italy: prevalence and risk factors. Eur J Paediatr Neurol. 2011;15:234–40. https://doi.org/10.1016/j.ejpn.2010.11.005. CrossRefPubMed
Karlı N, Akış N, Zarifoğlu M, Akgöz S, İrgil E, Ayvacıoğlu U, et al. Headache prevalence in adolescents aged 12 to 17: a student-based epidemiological study in Bursa. Headache J Head Face Pain. 2006;46:649–55. https://doi.org/10.1111/j.1526-4610.2006.00362.x. CrossRef
Kröner-Herwig B, Heinrich M, Morris L. Headache in German children and adolescents: a population-based epidemiological study. Cephalalgia. 2007;27:519–27. https://doi.org/10.1111/j.1468-2982.2007.01319.x. CrossRefPubMed
Abu-Arafeh I, Razak S, Sivaraman B, Graham C. Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies. Dev Med Child Neurol. 2010;52:1088–97. https://doi.org/10.1111/j.1469-8749.2010.03793.x. CrossRefPubMed
Ostkirchen GG, Andler F, Hammer F, Pöhler KD, Snyder-Schendel E, Werner NK, et al. Prevalences of primary headache symptoms at school-entry: a population-based epidemiological survey of preschool children in Germany. J Headache Pain. 2006;7:331–40. https://doi.org/10.1007/s10194-006-0325-z. CrossRefPubMedPubMedCentral
Goto M, Yokoyama K, Nozaki Y, Itoh K, Kawamata R, Matsumoto S, et al. Characteristics of headaches in Japanese elementary and junior high school students: a school-based questionnaire survey. Brain and Development. 2017;39:791–8. https://doi.org/10.1016/j.braindev.2017.05.010. CrossRefPubMed
Pothmann R, Frankenberg SV, Müllcr B, Sartory G, Hellmeier W. Epidemiology of headache in children and adolescents: evidence of high prevalence of migraine among girls under 10. Int J Behav Med. 1994;1:76–89. https://doi.org/10.1207/s15327558ijbm0101_5. CrossRefPubMed
Wang J, Visness CM, Calatroni A, Gergen PJ, Mitchell HE, Sampson HA. Effect of environmental allergen sensitization on asthma morbidity in inner-city asthmatic children. Clin Exp Allergy. 2009;39(9):1381. https://doi.org/10.1111/j.1365-2222.2009.03225.x. CrossRefPubMedPubMedCentral
Van Gessel H, Gassmann J, Kröner-Herwig B. Children in pain: recurrent back pain, abdominal pain, and headache in children and adolescents in a four-year-period. J Pediatr. 2011;158:977–83. https://doi.org/10.1016/j.jpeds.2010.11.051. CrossRefPubMed
He M, Yu S, Liu R, Yang X, Zhao G, Qiao X, et al. Familial occurrence of headache disorders: a population-based study in mainland China. Clin Neurol Neurosurg. 2016;149:143–6. https://doi.org/10.1016/j.clineuro.2016.08.010. CrossRefPubMed
Fendrich K, Vennemann M, Pfaffenrath V, Evers S, May A, Berger K, et al. Headache prevalence among adolescents--the German DMKG headache study. Cephalalgia. 2007;27:347–54. https://doi.org/10.1111/j.1468-2982.2007.01289.x. CrossRefPubMed
Slater S, Crawford M, Kabbouche M, LeCates S, Cherney S, Vaughan P, et al. Effects of gender and age on Paediatric headache. Cephalalgia. 2009;29:969–73. https://doi.org/10.1111/j.1468-2982.2008.01827.x. CrossRefPubMed
Fichtel A, Larsson B. Psychosocial impact of headache and comorbidity with other pains among Swedish school adolescents. Headache. 2002;42:766–75. http://www.ncbi.nlm.nih.gov/pubmed/12390639. Accessed 1 May 2017 CrossRefPubMed
Fearon P, Hotopf M. Relation between headache in childhood and physical and psychiatric symptoms in adulthood: national birth cohort study. BMJ. 2001;322:1145. http://www.ncbi.nlm.nih.gov/pubmed/11348907. Accessed 12 Jun 2017 CrossRefPubMedPubMedCentral
Bandell-Hoekstra IENG, Abu-Saad HH, Passchier J, Frederiks CMA, Feron FJM, Knipschild P. Coping and Quality of life in relation to headache in Dutch schoolchildren. Eur J Pain. 2002;6:315–21. http://www.ncbi.nlm.nih.gov/pubmed/12161097. Accessed 1 May 2017 CrossRefPubMed
Guidetti V, Galli F. Evolution of headache in childhood and adolescence: an 8-year follow-up. Cephalalgia. 1998;18:449–54. https://doi.org/10.1111/j.1468-2982.1998.1807449.x. CrossRefPubMed
Zebenholzer K, Wöber C, Kienbacher C, Wöber-Bingöl Ç. Migrainous disorder and headache of the tension-type not fulfilling the criteria: a follow-up study in children and adolescents. Cephalalgia. 2000;20:611–6. https://doi.org/10.1111/j.1468-2982.2000.00090.x. CrossRefPubMed
Balestri M, Papetti L, Maiorani D, Capuano A, Tarantino S, Battan B, et al. Features of aura in paediatric migraine diagnosed using the ICHD 3 beta criteria. Cephalalgia. 2017;33310241774857; https://doi.org/10.1177/0333102417748571.
- Clinical characteristics of headache in Italian adolescents aged 11–16 years: a cross-sectional questionnaire school-based study
Mara De Amici
Gian Luigi Marseglia
- BioMed Central