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Meta-Analysis
. 2023 Feb 14;24(1):8.
doi: 10.1186/s10194-023-01541-0.

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

Agnese Onofri  1 , Umberto Pensato  2   3 , Chiara Rosignoli  1 , William Wells-Gatnik  4 , Emily Stanyer  5 , Raffaele Ornello  1 , Hui Zhou Chen  5 , Federico De Santis  1 , Angelo Torrente  6 , Petr Mikulenka  7 , Gabriele Monte  8 , Karol Marschollek  9 , Marta Waliszewska-Prosół  9 , Wietse Wiels  10 , Deirdre M Boucherie  11 , Dilara Onan  12 , Fatemeh Farham  13 , Linda Al-Hassany  11 , Simona Sacco  14 ; European Headache Federation School of Advanced Studies (EHF-SAS)
Affiliations
Meta-Analysis

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

Agnese Onofri et al. J Headache Pain. .

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.

Keywords: Child and adolescent headache; Headache epidemiology; Meta-analysis; Migraine; Prevalence; Systematic review; Tension-type headache.

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Conflict of interest statement

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.

Figures

Fig. 1
Fig. 1
Review process and the reasons for paper exclusion
Fig. 2
Fig. 2
Graphic national representation of the population samples included in each study. Red—Countries reporting 5 or more prevalence studies; Orange—Countries reporting up to 4 prevalence studies; Yellow—Countries reporting up to 2 prevalence studies
Fig. 3
Fig. 3
Forest plot of the overall weighted prevalence data of migraine (A), migraine without aura (B), migraine with aura (C). Total: total population sample; Events: number of primary headache diagnosis; CI: Confidence Interval
Fig. 4
Fig. 4
Forest plot of the overall weighted prevalence data of tension type headache. Total: total population sample; Events: number of primary headache diagnosis; CI: Confidence Interval
Fig. 5
Fig. 5
Forest plot of the overall weighted prevalence data of primary headache (A) and unclassified headache (B). Total: total population sample; Events: number of primary headache diagnosis; CI: Confidence Interval
See this image and copyright information in PMC

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