1.gif (1892 bytes)

Brief Reports

Indian Pediatrics 2003; 40:665-669 

Prevalence and Characteristics of Migraine among Adolescents: A Questionnaire Survey

D. Shivpuri, M.S. Rajesh and D. Jain

From the Department of Pediatric Medicine, S.M.S. Medical College and Sir Padampat Mother & Child Health Institute, Jaipur, India.

Correspondence to: Dr. Deepak Shivpuri, B-13, Dhruv Marg, Tilak Nagar, Jaipur 302 004, India.
E-mail: [email protected]

Manuscript received: April 10, 2002; Initial review completed: May 13, 2002;
Revision accepted: February 5, 2003.

Abstract:

A screening questionnaire was distributed to 1000 boys and 1000 girls, studying in classes VI to X (11 to 15 years) in two public schools of Jaipur. Questionnaire A consisted of a single question to parents, "Does your child suffer from recurrent headache?" To those who reponded in the affirmative, a detailed questionnaire (B) was distributed. Questionnaire B consisted of twenty questions pertaining to characteristics and associations of headache. From questionnaire B a diagnosis of common migraine was made according to IHS criteria (1988). The prevalence of recurrrent headache was found to be 18% in boys and 21% in girls, while the prevalence of migraine was 9% in boys and 14% in girls. Among the other causes of recurrent headache tension type headache was seen in 3.6%, eye problems in 0.38%, sinusitis in 0.22%, and undetermined etiology in 2.14% children. The clinical characteristics of migraine are described.

Key words: Adolescents, Migraine, Recurrent headache

Headache is one of the most common neurological complaints in children, yet consultation rates do not reveal the true prevalence(1). Recurrent headaches adversely affect academic performance, memory, school attendance, personality and peer relations. The most common cause of recurrent headache severe enough for a child to be brought to a pediatrician is migraine, accounting for 50% of recurrent headaches. A large proportion of remaining headaches are caused by stress, anxiety or tension with resulting muscle contraction(2). Almost 80% of migraine attacks are without aura i.e., common migraine.

This study was conducted to find out the prevalence of recurrent headache and migraine in adolescent children at Jaipur and to describe the clinical characteristics of migranous headache.

Subjects and Methods

A pilot study was first conducted at St. Anselm’s Pink City School, Jaipur. Encouraged by the response of the school and the parents, a larger study was carried out in two public schools of Jaipur, namely St. Xavier’s Senior Secondary School and Maharani Gayatri Devi School. A screening questionnaire (A) was distributed to 1000 boys and 1000 girls, studying in classes VI to X (11 to 15 years). Questionnaie A consisted of a single question to parents, "Does your child suffer from recurrent headache?" To those who responded in the affirmative, a detailed questionnaire (B) was distributed. Question-naire B (appendix) consisted of twenty questions pertaining to characteristics and associations of headache. From Questionnaire B a diagnosis of migraine was made according to IHS criteria 1988 (Table I)(3).

Table I
Diagnostic Criteria for Common Migraine(3)
A.	At least 5 attacks fulfilling B - D.
B.	Headache attacks lasting 4-72 hours, untreated or unsuccessfully treated.
C.	Headache has at least two of the following characteristics:
	(i)	unilateral location
	(ii) pulsating quality
	(iii) moderate/severe intensity
	(iv) aggravated by walking, climbing stairs or routine physical activity
D.	During headache, at least one of the following:
	(i)	nausea and/or vomiting
	(ii)	photophobia/phonophobia

 

Results

Of the 1000 boys and 1000 girls distributed questionnaire A, 750 boys and 555 girls responded (response rate 65.2% overall, 75% among boys and 55% among girls). Recurrent headache was reported in 255 (19.5%) children 11-15 years of age (18% among boys and 21% among girls). Questionnaire B was distributed to these children. 125 boys (91%) and 103 girls (87%) returned their completed questionnaires (response rate 89%). Migraine was diagnosed in 145 children (11%): 67 (9%) boys and 78 (14%) girls. The other causes of headache included tension type headache in 3.6%, eye problems in 0.38%, sinusitis in 0.22% and cause undertermined in 2.14%.

Among the 145 children with migraine the headache was found to be unilateral in 64 (44%), it had a pulsating quality in 77 (53%), interfered with play in 80 (55%), aggravated by routine physical activities in 84 (58%), associated with nausea and vomiting in 48 (33%), photophobia/phonophobia in 77 (53%), and visual aura in 2 (1.37%).

Resolution of headache was spontaneous in 61 (42%), after medication in 25 (18%), and after sleep in 84 (58%). Eighty four (58%) parents of children with migraine had never consulted a doctor for headache. A positive family history of migraine was found in 51 (35%) children, 26% among mothers and 9% among fathers. Neuro-imaging studies had been done in 7 (4.8%): CT scan in 5 (3.4%), MRI in 2 (1.37%) children. Telephonic follow-up at the end of 1 year revealed that all children were doing well, the frequency and severity of headaches had reduced, and none had undertaken any neuro-imaging studies during this period.

Discussion

Eighteen per cent of boys and 21% of girls in the age group 11-15 years were found to suffer from recurrent headache. Of these 80% had headache severe enough to interfere with play or routine activity. 25% of children started having headache from 5-6 years of age. The prevalence of recurrent headache is reported to be 35.6% in American Indian adolescents, 32.1% in white American adolescents(4), 37% in Polish children(5), 23% in 7-15 years old Swedish school children(6), 36.9% in primary school children in UAE(7) and 2.8% in primary school children in Hong Kong(8). Recurrent head-ache was found to be a significant cause of school absenteeism.

A diagnosis of migraine was made in 9% boys and 14% girls in our study population using IHS criteria. Of these less than 2% had migraine with aura. Migraine prevalence is reported to be 5.3% in 15 year old Swedish children(9), 6.2% in 4-15 year olf Greek children(10), 8.42% in 6-19 year old Polish children(5), and 10.6% in 5-15 year old British children(11). A study from Chennai reported a migraine prevalence of 4% in 7-15 year old Indian children(12).

Kramer found that 54% of chronic headache lasting more than 3 months in children were migraine and that chronic and recurrent headache without accompanying neurological symptoms are usually benign and do not need neuroimaging studies(13).

Problems in methodology include reliability and validity of self-report data during cross-sectional questionnaire surveys. Data would have been more reliable had the questionnaire response been validated with direct child and parent interviews.

The prevalence of migraine is higher in our study population compared with that from other parts of the world. One possible explanation is that our study population consisted of 11-15 years old children in whom the prevalence of migraine is high while other studies have considered a wider age group, thus diluting the prevalence.

Limitation of this study includes the possibility of bias in the diagnosis of migraine because the children and their parents were not directly interviewed at onset of study or on follow up. Further studies need to be undertaken to evaluate the underlying factors responsible for the high prevalence of migraine in our population.

Contributors: All the authors were involved in study design, data collection, analysis and writing the manuscript. DS shall act as guarantor.

Funding: None.

Competing Interestes: None stated.

Key Messages


The prevalence of recurrent headache was found to be 18% in boys and 21% in girls, while the prevalence of migraine was 9% in boys and 14% in girls in the 11-15 year age group.

• Among the other causes of recurrent headache, tension type headache was seen in 3.6%, eye problems in 0.38%, sinusitis in 0.22% and undetermined etiology in 2.14% children.

 

 

 References


 

1. Hockaday JM. Migraine in children. J Maternal Child Health 1991; 16: 246-247.

2. Prensky AL. Headache. In: Oski A, Editors. Principles and Practice of Pediatrics . 2nd edn. Philadelphia: J.B. Lippincott Company; 1994; pp. 2135-2136.

3. Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorder, neuralgias and facial pain. Cephalgia 1988; 8: 1-96.

4. Rhee H. Prevalence and predictors of head-aches in US adolescents. Headache 2000; 40: 528-538.

5. Krasnik A. Headaches in the population of school children in Poznan: Neurol Neurochir Pol 1999; 33: 111-125.

6. Egermark - Eriksson I. Prevalence of headache in Swedish school children - a questionnaire survey. Acta Pediatr Scand 1982; 135-140.

7. Benner A, Swadi H, Qassani, Uduman S. Prevalence of headache in school children in the UAE. Ann Saudi 1998; 18: 522-524.

8. Kong CK, Cheng WW, Wong LY. Epidemiology of headache in Hong Kiong primary level school children: questionnaire study. Hong Kong Med J 2001; 7: 29-33.

9. Bille B. A 40 year follow up school children with migraine. Cephalalgia. 1997; 17: 488-491.

10. Mavromichalis I, Anagnostopoulos D, Metaxas N, Papanastassiou E. Prevalence of migraine in school children and some clinical comparisons between migraine with and without aura. Headache 1999; 39: 728-736.

11. Abu-Arefeh I, Russell G. Prevalence of headache and migraine in school children. BMJ 1994; 309: 765-769.

12. Thilotlammal N, Chellaraj M. Migraine in children. Indian Pediatr 1994; 31: 1503- 1510.

13. Nevo Y, Kramer U. Clinical categorization of 312 children with chronic headache. Brain Dev 1994; 16: 441-444.

Home

Past Issue

About IP

About IAP

Feedback

Links

 Author Info.

  Subscription