Headache-attributed burden among children and adolescents in Georgia: estimates from a national cross-sectional...

We recently published an account of headache prevalence among children (6-11 years) and adolescents (12-17) in Georgia, reporting an age- and gender-adjusted 1-year estimate of 66.3% for all headache. With undifferentiated headache (UdH) defined as mild or moderate headache lasting < 1 h, age- and gender-adjusted prevalence of migraine was 22.2%, of tension-type headache (TTH) 9.5%, of UdH 30.2%, of probable medication-overuse headache (pMOH) 0.5%, and of other headache on ≥ 15 days/month (other H15+) 3.6%. Here, using the same definition of UdH, we present data on attributed burden, collected contemporaneously from the same participants. The study was within the worldwide programme of cross-sectional schools-based studies undertaken by the Global Campaign against Headache.

We used the Global Campaign's standardized protocol, selecting schools representative of the country. The child and adolescent versions of the structured Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire, translated into Georgian language, were completed by pupils under supervision in class. Headache diagnoses followed International Classification of Headache Disorders, edition 3 (ICHD-3), except for UdH, which was defined as mild or moderate headache lasting < 1 h. Burden enquiry was in multiple domains, including symptom burden, impaired participation and quality of life (QoL), with timeframes of 4 weeks and 1 day (the latter based on headache yesterday [HY]).

Symptom burden was evidenced by mean headache frequency of 4.3 days/4 weeks, duration 1.6 h, proportion of time in ictal state 1.5% and intensity 1.7 (mild to moderate). Of episodic headaches, migraine was the most frequent, longest lasting and most intense. Pupils with pMOH reported headache on 78.9% of all days. Except for pMOH, fewer than half of headache days were medicated. Headache was blamed for 0.7 days/4 weeks of missed school (3.5% of 20 days), although only 1.5% of the 1,910 pupils with headache in the last year were absent yesterday because of HY (this analysis could not capture lost days immediately preceding weekends or holidays, so underestimated by at least 20%). Almost one in five parents (18.3%) of children lost time from their own work because of their child's headache, but only 4.5% of parents of adolescents. Emotional impact and QoL scores both showed gradation across headache types (pMOH and other H15 + worse than migraine worse than TTH and UdH).

Headache among children and adolescents in Georgia is associated with individual- and population-level burdens that measurably and adversely affect health, wellbeing, education and participation in leisure activities. These findings are available to inform national education and health policies.