The burden attributable to headache disorders among children and adolescents in Mongolia: estimates from a national cross-sectional schools-based study.

BACKGROUND

Previously we have shown headache to be common among children (aged 6–11 years) and adolescents (aged 12–17) in Mongolia. This study estimates the headache-attributed burden from data collected in the same study. The purposes are to inform health and educational policies in Mongolia, and to enhance knowledge and understanding of the global burden of headache, particularly among these age groups.

METHODS

Following the generic protocol for Lifting The Burden’s global schools-based study, this cross-sectional survey administered structured questionnaires to pupils for mediated self-completion within classes in seven schools in four districts of the Capital city and three rural areas of Mongolia, selected to represent the country’s diversities. Headache diagnostic questions, except those for undifferentiated headache (UdH), were based on ICHD-3 criteria. Burden enquiry was conducted in multiple domains.

RESULTS

Among N = 4,266 school pupils, mean headache frequency was 4.1 days/4 weeks, of moderate average intensity and mostly short-lasting (mean 2.0 h). Mean proportion of time with headache was 1.2% (although 14.2% in those with probable medication-overuse headache [pMOH]). Symptomatic medication was taken for fewer than half of reported headaches. Pupils reported 2% of school time missed because of headache (17.5% in those with pMOH). The estimated risk of parental work loss in 4 weeks, due to a son’s or daughter’s headache, was 6.3% (15.6% for parents of children with migraine, 35.7% for pMOH). Emotional impact and quality-of-life scores both showed impact distinguishing between headache types (pMOH having greatest, followed by other headache on ≥ 15 days/month, migraine, tension-type headache and UdH).

CONCLUSIONS

The headache-attributed burdens among children and adolescents may not, from this evidence, be deemed to be heavy (although losses from school time are not trivial). Nevertheless, there may be opportunity to avert at least some of the future need for health care among adults in Mongolia (one third of whom have headache with significant associated burden, mostly migraine or H15+, unquestionably calling for professional health care) by addressing the problem among children and adolescents. The short duration of headache among young people greatly limits the possibilities for acute intervention, shifting the emphasis in management onto lifestyle modification.