Global Headache Burden Increased in Adolescents, Young Adults From 1990 to 2019

Overall headache burden increased among adolescents and young adults globally between 1990 and 2019, according to study findings published in The Journal of Headache and Pain.

Researchers at Soochow University in Suzhou, China conducted a global analysis of 204 countries and territories based on the latest dataset from the 2019 Global Burden of Disease (GBD) Study. They evaluated disease status and burden through the main indicators of incidence, prevalence, and years lived with disability (YLDs).

The researchers assessed the overall headache burden and specific headache burdens for migraine and tension-type headache (TTH) at global, regional, and national levels. They assessed sex pattern differences based on the ratio of female to male YLD rates. The researchers also analyzed the relationship between socioeconomic background and headaches among adolescents and young adults.

According to the 2019 GBD Study, 601,229,802 incident headache cases and 2,049,979,883 prevalent headache cases occurred globally among individuals between ages 10 and 54. The researchers calculated a total of 38,355,993 YLDs among adolescents and young adults in 2019. Regarding overall headaches globally, prevalence and YLDs increased by 1.39% and 3.94%, respectively, whereas incidence decreased by 0.71%.

In terms of the migraine subtype, the researchers observed:

• 72,479,349 incident cases (95% UI, 62,228,889-82,376,780),
• 938,932,847 prevalent cases (95% UI, 809,364,423-1,091,101,799), and
• 34,934,884 YLDs (95% UI, 4,726,361-80,644,048) globally in 2019.

In terms of the TTH subtype, the researchers noted:

• 528,750,453 incident cases (95% UI, 459,812,890-608,377,209),
• 1,552,912,194 prevalent cases (95% UI, 1,331,676,025-1,775,658,298), and
• 3,421,109 YLDs (95% UI, 986,631-12,058,300).

Regionally, the highest and lowest prevalence rates of overall headaches occurred in Western Europe and Eastern Sub-Saharan Africa, respectively. The highest and lowest incidence rates of overall headaches occurred in high-income North America and East Asia, respectively. The highest and lowest YLDs rates for overall headaches occurred in Western Europe and Eastern Sub-Saharan Africa, respectively.

Nationally, the highest and lowest prevalence rates of overall headaches occurred in Italy and Ethiopia, respectively. The highest and lowest incidence rates of overall headaches occurred in Norway and North Korea, respectively. The highest and lowest YLDs rates for overall headaches occurred in Belgium and Ethiopia, respectively.

The researchers noted increases of overall headache incidence rates in persons aged 20 to 39 and rapid decreases of those rates in following age groups. Overall headache prevalence rate reached its peak in persons aged 35 to 44, largely consistent with the prevalence rates of migraines and TTH. YLDs peaked in persons aged 40 to 44 for overall headache disorders, migraine, and TTH.

Compared with men, women presented with higher overall prevalence, incidence, and YLDs for all types of headaches. The researchers noted a decline in the ratio of female-to-male YLDs from 1990 to 2019, from 1.7 to 1.655 for overall headaches, 1.751 to 1.702 for migraine, and 1.267 to 1.247 for TTH.

For both overall headache disorders and migraine, the highest and lowest sex difference ratios occurred in Canada and Malaysia, respectively. For TTH, the highest and lowest ratios occurred in Spain and China, respectively.

Although inconsistent with previous study findings, this study found a positive correlation between local socioeconomic background and headache burden among young people, with regions with higher sociodemographic indexes (SDIs) showing greater YLD rates. The researchers hypothesized that the lack of reporting on headache prevalence, incidence, and YLDs in low- and low-to-middle-SDI regions could explain this correlation.

The researchers noted limitations, such as that the study’s results were based on estimations acquired from disease modelling and statistical calculations, which might not accurately reflect real-world data. Additional limitations included the lack of consideration for rare headache subtypes, such as cluster headaches, and the prospect of constant diagnostic criteria revision for overall headache disorders, increasing risk of bias.

“Overall, the global burden of headaches in adolescents and young adults largely increased from 1990 to 2019,” the researchers concluded. “Interdisciplinary actions involving education, policy- and law-making, and basic medical practice are desperately needed to further fight against the headache burden, promote gender equality in headache care, and eliminate the stigmatization of headache patients in student and working groups.”