Undifferentiated headache: broadening the approach to headache in children and adolescents, with supporting evidence from a nationwide school-based cross-sectional survey in Turkey

Abstract

BackgroundHeadache is a leading disabler in adults worldwide. In children and adolescents, the same may be true but the evidence is much poorer. It is notable that published epidemiological studies of these age groups have largely ignored headaches not fulfilling any specific set of ICHD criteria, although such headaches appear to be common. A new approach to these is needed: here we introduce, and investigate, a diagnostic category termed “undifferentiated headache” (UdH), defined in young people as recurrent mild-intensity headache of < 1 h’s duration.MethodsWe conducted a nationwide cross-sectional survey in 31 schools in six regions of Turkey selected by mixed convenience-based and purposive modified cluster-sampling. A validated, standardised self-completed structured questionnaire was administered by a physician-investigator to entire classes of pupils aged 6–17 years.ResultsOf the identified sample of 7889 pupils, 7088 (89.8%) participated. The 1-year prevalence of UdH was 29.2%, of migraine (definite and probable) 26.7%, and of tension-type headache (TTH) (definite and probable) 12.9%. UdH differed with respect to almost all headache features and associated symptoms from both migraine and TTH. Burden of headache and use of acute medication were lower in UdH than in migraine and TTH. Headache yesterday was less common in UdH than migraine (OR 0.32; 95% CI 0.28–0.37) and TTH (OR 0.64; 95% CI 0.56–0.77). Quality of life (QoL) was better in UdH (33.6 ± 5.2) than in migraine (30.3 ± 5.6; p < 0.001) and TTH (32.4 ± 5.3; p < 0.001), but worse than in pupils without headache (35.7 ± 4.7; p < 0.001).ConclusionsThis large nationwide study in Turkey of pupils aged 6–17 years has shown that many children and adolescents have a headache type that does not conform to existing accepted diagnostic criteria. This new diagnostic category of presumably still-evolving headache (undifferentiated headache) is common. UdH differs in almost all measurable respects from both migraine and TTH. Although characterised by mild headaches lasting < 1 h, UdH is associated with significant adverse impact on QoL. Longitudinal cohort studies are needed to evaluate the prognosis of UdH but, meanwhile, recognition of UdH and its distinction from migraine and TTH has implications for epidemiological studies, public-health policy and routine clinical practice.

Prevalence of Primary Headache Disorder Among Primary and middle School students in Kuwait.

“…In contrast, Rho et al reported tension type headache as the most frequent type among Korean schoolchildren followed by migraine headache [21]. Undifferentiated headache in our cohort was scarce, only 7 cases 0.6% which is in disagreement with previous results in Turkey [25]. This discrepancy may be explained by that in our study we reviewed every case with headache to con rm the accurate diagnosis.…”

“…headaches. This was similarly documented by other studies where migraine headache was followed in frequency by other headache types [18,24,25]. In contrast, Rho et al reported tension type headache as the most frequent type among Korean schoolchildren followed by migraine headache [21].…”

Comparison of Children with Migraine and Those with Tension-Type Headache for Psychiatric Symptoms and Quality of Life

“…26,34,60 However, several studies have compared the QoL of children with migraine and TTH in childhood and found no significant differences on any QoL subscale between two headache groups. 25,30 To gain more insight into the effect of different types of headache on the QoL, far greater efforts are needed.…”

“…[25][26][27][28][29] Some studies also compared the QoL of children with migraine with that of children with TTH and found no significant difference between the two groups. 25,30 There is an uncertainty regarding the determinants of QoL in children with headache due to methodological differences. For instance, some studies have considered only the effects of the headache-specific factors, such as age at onset, duration, severity of headache, and sociodemographic factors, on the QoL.…”

Kopfschmerz im Kindes- und Jugendalter

“…DiesenDatenisteinvalidierterFragebogenzugrundegelegt,der erstmals in einer epidemiologischen Studie in der Türkei eingesetzt wurdeundweltweitVerwendungfindet [5][6][7][8][9][10].InDeutschland wurde für die Altersgruppe der 9-bis 14-Jährigen eine Migräneprävalenz von 13,1 % und eine Prävalenz des Spannungskopfschmerzes von 17,6 % erhoben, wobei Mädchen sowohl eine höhere Kopfschmerzprävalenz wie auch eine höhere Kopfschmerzfrequenz berichteten [11]. In einer weiteren Studie aus Deutschland war die Inzidenz der Migräne bis zum 9.…”