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