Global and Regional Trends in Headache Disorders Among Children and Adolescents Aged 5–19 findings from the global burden of disease study 2021

Ruofan Zhao; Xiaojing Yao; Guizeng Zhao

doi:10.71321/4ex31563

Authors

Ruofan Zhao Academy of Medical Sciences of Zhengzhou University
Xiaojing Yao The Third Affiliated Hospital of Zhengzhou University
Guizeng Zhao The first Affiliated Hospital of Xinxiang Medical College

DOI:

https://doi.org/10.71321/4ex31563

Keywords:

headache disorders, migraine, tension-type headache, incidence, prevalence, Global Burden of Disease (GBD), disability-adjusted life years (DALYs), epidemiology, adolescents, children

Abstract

Background: As highlighted in the Global Burden of Disease (GBD) study, headache disorders represent a major cause of non-fatal disease burden worldwide, given their widespread prevalence and impact on daily functioning. In recent years, the prevalence of headache disorders has risen substantially among children and adolescents, with significant repercussions for their daily functioning and overall well-being. However, despite their growing impact, there remains a critical shortage of comprehensive investigations into the burden and long-term implications of these conditions in younger populations. This study systematically assesses the global and regional burden of headache disorders in individuals aged 5 to 19 years over the period 1990 to 2021, aiming to generate high-resolution epidemiological insights to inform public health strategies and guide data-driven policy decisions.
Methods: The 2021 iteration of the GBD study quantified the impact of 371 diseases and injuries through estimates of disability-adjusted life years (DALYs), incidence, and prevalence, integrating data from over 100,000 heterogeneous sources spanning registries, surveys, and health records. Data inputs included vital registration systems, verbal autopsies, national censuses, household surveys, disease-specific registries, healthcare utilization databases, and other relevant sources. DALYs were computed as the sum of years lived with disability (YLDs) and years of life lost (YLLs). YLDs were estimated by multiplying the prevalence of each health sequela—stratified by cause, age, sex, location, and year—by its assigned disability weight. In parallel, YLLs were computed by applying the standard life expectancy, derived from the reference life table, to the number of deaths within each demographic subgroup.
Results: From 1990 to 2021, headache disorders consistently imposed a significant global burden on individuals aged 5 to 19. By 2021, the age-standardized incidence rate (ASIR) was 7,874 per 100,000, and the age-standardized prevalence rate (ASPR) reached 19,866 per 100,000, with a DALY rate of 294 per 100,000. Females consistently had higher rates than males across all indicators. Middle-SDI regions contributed the highest total number of cases and DALYs, while high-SDI regions had the highest age-standardized rates. Temporal trend analysis showed the steepest increase in DALY rates in middle- and high-middle-SDI regions, particularly among adolescents aged 15-19. Among headache subtypes, migraine, despite its lower prevalence, contributed more to DALYs due to its higher disability weight. Improved healthcare access and disease recognition in regions with advanced diagnostic infrastructure may lead to more accurate migraine diagnoses, while stigma and limited awareness can delay recognition, further exacerbating its disability burden.
Conclusion: Headache disorders remain a significant and persistent health burden among children and adolescents worldwide, with migraine contributing most to disability. Targeted interventions and integration of headache care into primary health systems are urgently needed to address this growing challenge.
Keywords: headache disorders, migraine, tension-type headache, incidence, prevalence, Global Burden of Disease (GBD), disability-adjusted life years (DALYs), epidemiology, adolescents, children

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