Global epidemiology and burden of headache disorders in children and adolescents from 1990 to 2021

We aimed to present an updated epidemiological overview of headache disorders among children and adolescents, utilizing the latest data from the Global Burden of Disease (GBD) 2021. Large-sample epidemiological studies on headache disorders in children and adolescents have been limited due to their demographic uniqueness, with previous GBD studies rarely focusing on this age group, until the GBD 2021 study provided a significant update. A secondary analysis of headache disorder data from the GBD 2021 for individuals aged 0-<20 years was conducted. The analysis focused on estimating the prevalence, incidence, and disability-adjusted life-years (DALYs), as well as the estimated annual percentage changes (EAPCs). Data from 204 countries and regions, stratified by sociodemographic index (SDI), were included to assess variations in headache disorder metrics across different age groups, sexes, and socioeconomic settings. Between 1990 and 2021, the global prevalence, incidence, and DALYs of headache disorders in children and adolescents rose by 22.79% (95% uncertainty interval [UI] 21.68-23.82%), 5.21% (95% UI 4.26-6.10%), and 24.27% (95% UI 20.35-26.91%) per 100,000 population, respectively. In 2021, 545,824,485 (95% UI 448,777,920-641,644,106) children and adolescents were affected, with a prevalence of 20.71% (95% UI 17.03-24.34%). Migraine affected 205,729,235 (95% UI 158,825,540-265,306,014) with a prevalence of 7.81%, and tension-type headache (TTH) affected 394,543,039 (95% UI 300,611,322-499,598,953) with a prevalence of 14.97%. The DALYs totaled 8,102,465 (95% UI 716,310-19,266,508), with migraine at 7,515,775 (95% UI 486,575-18,715,548), and TTH at 586,690 (95% UI 94,646-2,924,761). The 15-19 years age group had the highest prevalence (41.38%, 95% UI 32.73-50.58%), while the 10-14 years age group had the highest incidence (12.75%, 95% UI 9.09-16.72%). High SDI regions had the highest prevalence and DALYs; however, low-middle SDI regions experienced the fastest growth. Brazil had the highest prevalence (30.55%, 95% UI 26.44-34.65%); India had the most DALYs (1,716,049, 95% UI 138,743-4,051,479); the Northern Mariana Islands had the largest prevalence increase (EAPC 0.97, 95% confidence interval [CI] 0.67-1.26), and Norway had the highest DALYs increase (EAPC 1.31, 95% CI 0.98-1.64). Headache disorders in children and adolescents are emerging as critical public health challenges, especially in regions where resources are limited. It is essential to strengthen public health education and advocate for evidence-based strategies to reduce the burden.