The prevalence of headache disorders among children and adolescents in Georgia: a cross-sectional schools-based study

The Global Campaign against Headache is undertaking a worldwide programme of cross-sectional schools-based studies of headache prevalence and attributed burden among children (6-11 years) and adolescents (12-17). The purpose is to expand the still sparse knowledge of headache among these age groups, using a data-acquisition technique that cluster-samples the world. This survey in Georgia was the fourth in the European Region, following similar studies in Turkey, Austria and Lithuania, and others in African, Eastern Mediterranean, South-East Asia and Western Pacific Regions.

We used the Global Campaign's standardized protocol, selecting schools representative of the country. The child and adolescent versions of the structured HARDSHIP questionnaire, translated into Georgian language, were completed by pupils under supervision in class. Headache diagnoses followed ICHD-3, with the exception of undifferentiated headache (UdH), which we defined initially as mild and subsequently as mild-to-moderate headache lasting < 1 h. Enquiry timeframes were 1 year, 4 weeks and 1 day (headache yesterday [HY]).

Of 2,790 participants, two thirds (68.5%) reported headache in the preceding year (age- and gender-adjusted 1-year prevalence: 66.3%). HY was reported by 20.4%, a proportion that might be expected to have headache on any day. Headache on ≥ 15 days/month (H15+) was common (4.1%), with probable medication-overuse headache (pMOH) accounting for 0.5% (0.2% among children, 0.7% among adolescents; p = 0.06). UdH took diagnostic precedence over migraine and tension-type headache (TTH), so all other estimates were influenced by the definition of UdH. By the conventional (initial) definition, 1-year prevalence of UdH was 18.2%; by the modified definition, it was 30.2%. Estimates for migraine and TTH, 29.1% and 13.1% respectively with UdH defined conventionally, were reduced to 22.2% and 9.5% with the modified definition.

Headache is very common among children and adolescents in Georgia. The findings raise particular concern about the prevalence of H15 + in young people, with a strong trend of increasing pMOH with age. They also highlight the diagnostic uncertainties inherent in epidemiological studies in these age groups. With the definition of UdH a dominating issue, the findings support the view that it needs to be modified, without offering a definitive solution.