Headache among adolescents in the general population: Prevalence, impairment and assessment methods
Abstract
Headache is one of the most common health problems in adolescents and can negatively
affect their quality of life, impair daily function and lead to the development of psychological
problems. Adolescence is a period of great strain due to mental and somatic changes
associated with development. Therefore, we decided to study the prevalence and burden of
headache among adolescents in Norway with a focus on all headaches rather than on only the
most bothersome cases commonly addressed by previous epidemiological surveys. In
addition, we wanted to develop an internet-based headache diary to see whether it was more
useful than a paper diary in terms of adherence. Finally, we explored whether the data in the
diary provide information about headaches among adolescents that is not captured by a
retrospective interview and/or questionnaire.
The thesis was designed both as a cross-sectional study (examining a representative
community sample of 488 adolescents aged 12–18 years recruited from mid-Norway) and as a
prospective study (three weeks of diary entries). Headache diagnoses were determined using
the criteria set down by the International Headache Society (ICHD-3 beta, 2013), and the
standardised Pediatric Migraine Disability Assessment (PedMIDAS) was used to evaluate
disability due to headache.
We found a high one-year prevalence rate of any headache (88%), as well as migraine (36%)
and tension-type headache (58%), among adolescents; however, there was a low level of
headache-related disability according to the PedMIDAS. With respect to prospective diary
entries about headache intensity and frequency, and use of medication, we found that internetbased
diaries provided more reliable and credible estimates of headache parameters than
paper diaries. Finally, we found that prospective diary recordings during a three-week period
provided important information that could supplement results obtained from structured
interviews. Therefore, we recommend the use of prospective diary recordings to supplement
information obtained at interview when assessing frequent headaches among adolescents and
their use of medication, both in the school health service and in clinical practice.