Primary headache epidemiology in children and adolescents: a systematic review and meta-analysis

Agnese Onofri; Umberto Pensato; the European Headache Federation School of Advanced Studies (EHF-SAS); Chiara Rosignoli; William Wells-Gatnik; Emily Stanyer; Raffaele Ornello; Hui Zhou Chen; Federico De Santis; Angelo Torrente; Petr Mikulenka; Gabriele Monte; Karol Marschollek; Marta Waliszewska-Prosół; Wietse Wiels; Deirdre M. Boucherie; Dilara Onan; Fatemeh Farham; Linda Al-Hassany; Simona Sacco

doi:10.1186/s10194-023-01541-0

Primary headache epidemiology in children and adolescents: a systematic review and meta-analysis

Agnese Onofri, Umberto Pensato, the European Headache Federation School of Advanced Studies (EHF-SAS), Chiara Rosignoli, William Wells-Gatnik, Emily Stanyer, Raffaele Ornello, Hui Zhou Chen, Federico De Santis, Angelo Torrente, Petr Mikulenka, Gabriele Monte, Karol Marschollek, Marta Waliszewska-Prosół, Wietse Wiels, Deirdre M. Boucherie, Dilara Onan, Fatemeh Farham, Linda Al-Hassany, Simona Sacco^*

^*Corresponding author for this work

Internal Medicine

Research output: Contribution to journal › Review article › Academic › peer-review

92 Citations (Scopus)

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Abstract

Introduction: Headache is the most prevalent neurological manifestation in adults and one of the leading causes of disability worldwide. In children and adolescents, headaches are arguably responsible for a remarkable impact on physical and psychological issues, yet high-quality evidence is scarce. Material and methods: We searched cross-sectional and cohort studies in Embase, Medline, Web of Science, and Cochrane databases from January 1988 to June 2022 to identify the prevalence of headaches in 8–18 years old individuals. The risk of bias was examined with the Joanna Briggs Institute (JBI) scale. A random-effects model was used to estimate the pooled prevalence of pediatric headache. Subgroup analyses based on headache subtypes were also conducted. Results: Out of 5,486 papers retrieved electronically, we identified 48 studies that fulfilled our inclusion criteria. The pooled prevalence of primary headaches was 11% for migraine overall [95%CI: 9–14%], 8% for migraine without aura (MwoA) [95%CI: 5–12%], 3% for migraine with aura (MwA) [95%CI:2–4%] and 17% for tension-type headache (TTH) [95% CI: 12–23%]. The pooled prevalence of overall primary headache in children and adolescents was 62% [95% CI: 53–70%], with prevalence in females and males of 38% [95% CI: 16–66%] and 27% [95% CI: 11–53%] respectively. After the removal of studies ranked as low-quality according to the JBI scale, prevalence rates were not substantially different. Epidemiological data on less common primary headaches, such as trigeminal autonomic cephalalgias, were lacking. Conclusion: We found an overall remarkably high prevalence of primary headaches in children and adolescents, even if flawed by a high degree of heterogeneity. Further up-to-date studies are warranted to complete the picture of pediatric headache-related burden to enhance specific public interventions.

Original language	English
Article number	8
Journal	Journal of Headache and Pain
Volume	24
Issue number	1
DOIs	https://doi.org/10.1186/s10194-023-01541-0
Publication status	Published - 14 Feb 2023

Bibliographical note

Funding Information:
SS reports consultant, advisory board, or speaker fees from Abbott, Allergan, AstraZeneca, Bayer, Bristol Myers Squibb, DaiichiSankyo, Eli Lilly, Medscape, Medtronic, Novartis, Starmed, Teva, and Uriach. RO reports speaker fees from Eli Lilly, Novartis, and Teva, support for attending meetings or travel from Novartis and Teva, advisory board fees from Eli Lilly, and nonfinancial support from Allergan and Novartis. PM reports personal support from Charles University Research Program Cooperatio–Neuroscience. WW reports personal support from FWO (Vlaanderen Fundamental Research Scholar). The authors AO, CR, WWG, KM, FDS, HZC, ES, GM, DMB, DO, FF, MW, AT, UP, LAH declare that they have no competing interests.

Funding Information:
The authors wish to thank Dr M.F.M. (Maarten) Engel from the Erasmus MC Medical Library (Rotterdam, the Netherlands) for developing the search strategy.

Publisher Copyright:
© 2023, The Author(s).

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Primary headache epidemiology in children and adolescentsFinal published version, 3.39 MBLicence: CC BY

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Onofri, A., Pensato, U., the European Headache Federation School of Advanced Studies (EHF-SAS), Rosignoli, C., Wells-Gatnik, W., Stanyer, E., Ornello, R., Chen, H. Z., De Santis, F., Torrente, A., Mikulenka, P., Monte, G., Marschollek, K., Waliszewska-Prosół, M., Wiels, W., Boucherie, D. M., Onan, D., Farham, F., Al-Hassany, L., & Sacco, S. (2023). Primary headache epidemiology in children and adolescents: a systematic review and meta-analysis. Journal of Headache and Pain, 24(1), Article 8. https://doi.org/10.1186/s10194-023-01541-0

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abstract = "Introduction: Headache is the most prevalent neurological manifestation in adults and one of the leading causes of disability worldwide. In children and adolescents, headaches are arguably responsible for a remarkable impact on physical and psychological issues, yet high-quality evidence is scarce. Material and methods: We searched cross-sectional and cohort studies in Embase, Medline, Web of Science, and Cochrane databases from January 1988 to June 2022 to identify the prevalence of headaches in 8–18 years old individuals. The risk of bias was examined with the Joanna Briggs Institute (JBI) scale. A random-effects model was used to estimate the pooled prevalence of pediatric headache. Subgroup analyses based on headache subtypes were also conducted. Results: Out of 5,486 papers retrieved electronically, we identified 48 studies that fulfilled our inclusion criteria. The pooled prevalence of primary headaches was 11% for migraine overall [95%CI: 9–14%], 8% for migraine without aura (MwoA) [95%CI: 5–12%], 3% for migraine with aura (MwA) [95%CI:2–4%] and 17% for tension-type headache (TTH) [95% CI: 12–23%]. The pooled prevalence of overall primary headache in children and adolescents was 62% [95% CI: 53–70%], with prevalence in females and males of 38% [95% CI: 16–66%] and 27% [95% CI: 11–53%] respectively. After the removal of studies ranked as low-quality according to the JBI scale, prevalence rates were not substantially different. Epidemiological data on less common primary headaches, such as trigeminal autonomic cephalalgias, were lacking. Conclusion: We found an overall remarkably high prevalence of primary headaches in children and adolescents, even if flawed by a high degree of heterogeneity. Further up-to-date studies are warranted to complete the picture of pediatric headache-related burden to enhance specific public interventions.",

author = "Agnese Onofri and Umberto Pensato and {the European Headache Federation School of Advanced Studies (EHF-SAS)} and Chiara Rosignoli and William Wells-Gatnik and Emily Stanyer and Raffaele Ornello and Chen, {Hui Zhou} and {De Santis}, Federico and Angelo Torrente and Petr Mikulenka and Gabriele Monte and Karol Marschollek and Marta Waliszewska-Pros{\'o}{\l} and Wietse Wiels and Boucherie, {Deirdre M.} and Dilara Onan and Fatemeh Farham and Linda Al-Hassany and Simona Sacco",

note = "Funding Information: SS reports consultant, advisory board, or speaker fees from Abbott, Allergan, AstraZeneca, Bayer, Bristol Myers Squibb, DaiichiSankyo, Eli Lilly, Medscape, Medtronic, Novartis, Starmed, Teva, and Uriach. RO reports speaker fees from Eli Lilly, Novartis, and Teva, support for attending meetings or travel from Novartis and Teva, advisory board fees from Eli Lilly, and nonfinancial support from Allergan and Novartis. PM reports personal support from Charles University Research Program Cooperatio–Neuroscience. WW reports personal support from FWO (Vlaanderen Fundamental Research Scholar). The authors AO, CR, WWG, KM, FDS, HZC, ES, GM, DMB, DO, FF, MW, AT, UP, LAH declare that they have no competing interests. Funding Information: The authors wish to thank Dr M.F.M. (Maarten) Engel from the Erasmus MC Medical Library (Rotterdam, the Netherlands) for developing the search strategy. Publisher Copyright: {\textcopyright} 2023, The Author(s).",

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doi = "10.1186/s10194-023-01541-0",

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Onofri, A, Pensato, U, the European Headache Federation School of Advanced Studies (EHF-SAS), Rosignoli, C, Wells-Gatnik, W, Stanyer, E, Ornello, R, Chen, HZ, De Santis, F, Torrente, A, Mikulenka, P, Monte, G, Marschollek, K, Waliszewska-Prosół, M, Wiels, W, Boucherie, DM, Onan, D, Farham, F, Al-Hassany, L & Sacco, S 2023, 'Primary headache epidemiology in children and adolescents: a systematic review and meta-analysis', Journal of Headache and Pain, vol. 24, no. 1, 8. https://doi.org/10.1186/s10194-023-01541-0

TY - JOUR

T1 - Primary headache epidemiology in children and adolescents

T2 - a systematic review and meta-analysis

AU - Onofri, Agnese

AU - Pensato, Umberto

AU - the European Headache Federation School of Advanced Studies (EHF-SAS)

AU - Rosignoli, Chiara

AU - Wells-Gatnik, William

AU - Stanyer, Emily

AU - Ornello, Raffaele

AU - Chen, Hui Zhou

AU - De Santis, Federico

AU - Torrente, Angelo

AU - Mikulenka, Petr

AU - Monte, Gabriele

AU - Marschollek, Karol

AU - Waliszewska-Prosół, Marta

AU - Wiels, Wietse

AU - Boucherie, Deirdre M.

AU - Onan, Dilara

AU - Farham, Fatemeh

AU - Al-Hassany, Linda

AU - Sacco, Simona

N1 - Funding Information: SS reports consultant, advisory board, or speaker fees from Abbott, Allergan, AstraZeneca, Bayer, Bristol Myers Squibb, DaiichiSankyo, Eli Lilly, Medscape, Medtronic, Novartis, Starmed, Teva, and Uriach. RO reports speaker fees from Eli Lilly, Novartis, and Teva, support for attending meetings or travel from Novartis and Teva, advisory board fees from Eli Lilly, and nonfinancial support from Allergan and Novartis. PM reports personal support from Charles University Research Program Cooperatio–Neuroscience. WW reports personal support from FWO (Vlaanderen Fundamental Research Scholar). The authors AO, CR, WWG, KM, FDS, HZC, ES, GM, DMB, DO, FF, MW, AT, UP, LAH declare that they have no competing interests. Funding Information: The authors wish to thank Dr M.F.M. (Maarten) Engel from the Erasmus MC Medical Library (Rotterdam, the Netherlands) for developing the search strategy. Publisher Copyright: © 2023, The Author(s).

PY - 2023/2/14

Y1 - 2023/2/14

N2 - Introduction: Headache is the most prevalent neurological manifestation in adults and one of the leading causes of disability worldwide. In children and adolescents, headaches are arguably responsible for a remarkable impact on physical and psychological issues, yet high-quality evidence is scarce. Material and methods: We searched cross-sectional and cohort studies in Embase, Medline, Web of Science, and Cochrane databases from January 1988 to June 2022 to identify the prevalence of headaches in 8–18 years old individuals. The risk of bias was examined with the Joanna Briggs Institute (JBI) scale. A random-effects model was used to estimate the pooled prevalence of pediatric headache. Subgroup analyses based on headache subtypes were also conducted. Results: Out of 5,486 papers retrieved electronically, we identified 48 studies that fulfilled our inclusion criteria. The pooled prevalence of primary headaches was 11% for migraine overall [95%CI: 9–14%], 8% for migraine without aura (MwoA) [95%CI: 5–12%], 3% for migraine with aura (MwA) [95%CI:2–4%] and 17% for tension-type headache (TTH) [95% CI: 12–23%]. The pooled prevalence of overall primary headache in children and adolescents was 62% [95% CI: 53–70%], with prevalence in females and males of 38% [95% CI: 16–66%] and 27% [95% CI: 11–53%] respectively. After the removal of studies ranked as low-quality according to the JBI scale, prevalence rates were not substantially different. Epidemiological data on less common primary headaches, such as trigeminal autonomic cephalalgias, were lacking. Conclusion: We found an overall remarkably high prevalence of primary headaches in children and adolescents, even if flawed by a high degree of heterogeneity. Further up-to-date studies are warranted to complete the picture of pediatric headache-related burden to enhance specific public interventions.

AB - Introduction: Headache is the most prevalent neurological manifestation in adults and one of the leading causes of disability worldwide. In children and adolescents, headaches are arguably responsible for a remarkable impact on physical and psychological issues, yet high-quality evidence is scarce. Material and methods: We searched cross-sectional and cohort studies in Embase, Medline, Web of Science, and Cochrane databases from January 1988 to June 2022 to identify the prevalence of headaches in 8–18 years old individuals. The risk of bias was examined with the Joanna Briggs Institute (JBI) scale. A random-effects model was used to estimate the pooled prevalence of pediatric headache. Subgroup analyses based on headache subtypes were also conducted. Results: Out of 5,486 papers retrieved electronically, we identified 48 studies that fulfilled our inclusion criteria. The pooled prevalence of primary headaches was 11% for migraine overall [95%CI: 9–14%], 8% for migraine without aura (MwoA) [95%CI: 5–12%], 3% for migraine with aura (MwA) [95%CI:2–4%] and 17% for tension-type headache (TTH) [95% CI: 12–23%]. The pooled prevalence of overall primary headache in children and adolescents was 62% [95% CI: 53–70%], with prevalence in females and males of 38% [95% CI: 16–66%] and 27% [95% CI: 11–53%] respectively. After the removal of studies ranked as low-quality according to the JBI scale, prevalence rates were not substantially different. Epidemiological data on less common primary headaches, such as trigeminal autonomic cephalalgias, were lacking. Conclusion: We found an overall remarkably high prevalence of primary headaches in children and adolescents, even if flawed by a high degree of heterogeneity. Further up-to-date studies are warranted to complete the picture of pediatric headache-related burden to enhance specific public interventions.

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DO - 10.1186/s10194-023-01541-0

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AN - SCOPUS:85147930391

SN - 1129-2369

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JO - Journal of Headache and Pain

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Primary headache epidemiology in children and adolescents: a systematic review and meta-analysis

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