Headache-attributed burden among children and adolescents in Nepal: a national schools-based cross-sectional study

We recently published estimates of 1-year headache prevalence among children (6-11 years) and adolescents (12-17) in Nepal. Adjusted for age and gender, these were 83.9% for all headache, 39.5% for migraine, 31.7% for undifferentiated headache (UdH), 10.0% for tension-type headache (TTH), 0.3% for probable medication-overuse headache (pMOH) and 1.9% for other headache on ≥ 15 days/month (other H15+). Here we present estimates of attributed burden.

We followed the Global Campaign's standardised protocol. In nine schools representative of the country, the child and adolescent versions of the structured HARDSHIP questionnaire were completed by pupils in class under supervision. Headache diagnoses followed ICHD-3, except for UdH, defined here as mild or moderate headache with usual duration < 1 h. Burden enquiries were in multiple domains, with timeframes of 4 weeks and 1 day, the latter based on reports of headache yesterday (HY).

There were 2,352 participants (1,040 children [44.2%]; 1,312 adolescents [55.8%]) from 2,360 eligible (participating proportion 99.7%). Symptom burden was expressed as moderate headache on an average of 2.9 days/4 weeks, lasting for 2.0 h. Mean proportion of time in ictal state (pTIS) was 1.0%, but much higher among those with pMOH (11.0%) or other H15+ (9.4%). Except for pMOH, only one third of headache episodes were medicated. Lost school time was 3% estimated from recall over the preceding 4 weeks, with similar time lost from other (social and leisure) activities. Actual absences from school yesterday because of HY were more (4.5%), suggesting losses were underestimated by recall, but, since recorded absences yesterday failed to capture absences on days preceding weekends or holidays, true losses might have been 5-6%. More than one fifth (21.7%) of parents lost time from their own work. Both emotional impact and quality-of-life (QoL) scores were sensitive to headache (and headache type), showing gradients of negative impact (pMOH and other H15+ > migraine > TTH and UdH).

Symptom burden appeared to be relatively modest except for pMOH and H15+, but measures of impaired participation (including lost time from school), emotional impact and QoL all indicated material impact. Parents, teachers, health-care providers and policy makers should be aware of this.