The prevalence of headache disorders among adolescents in Vietnam: a cross-sectional schools-based study

Headache disorders are major contributors to non-fatal health loss in adolescents, but epidemiological data from Vietnam are lacking. This study aimed to estimate the prevalence of headache disorders among Vietnamese high school pupils and examine their associations with demographic and school-level characteristics. This cross-sectional, school-based study was conducted in Vietnam from January to March 2026 using the standardized methodology of the Global Campaign against Headache. Pupils aged 15–17 years from seven high schools representing diverse geographic and socioeconomic settings completed the Vietnamese-translated adolescent version of the HARDSHIP questionnaire under supervision. Headache diagnoses were assigned using the HARDSHIP diagnostic algorithm according to two approaches: the original criteria, defining UdH as mild headache lasting < 1 h, and modified criteria, defining undifferentiated headache (UdH) as mild-to-moderate headache lasting < 1 h. Enquiry timeframes were 1 year, 4 weeks, and 1 day, the latter assessed using the headache-yesterday (HY) question. Prevalence estimates were calculated with 95% confidence intervals (CIs), and associations were examined using logistic regression with robust standard errors to account for the clustered sampling design. Of 6,561 pupils available for inclusion, 6,312 participated, giving a participation rate of 96.2%. The mean age was 16.2 ± 0.8 years, and 56.5% were female. The lifetime prevalence of any headache was 93.6% (95% CI: 93.1–94.1), while the 1-year prevalence was 77.2% (95% CI: 74.0–80.1). Using the original approach, migraine was the most prevalent headache type, affecting 33.0% (95% CI, 29.8–36.4) of pupils, followed by UdH (17.7%, 95% CI, 16.3–19.2) and tension-type headache (TTH; 15.1%, 95% CI, 13.0–17.5). Using the modified approach, UdH prevalence increased to 34.4% (95% CI, 32.2–36.7), while the prevalences of migraine and TTH decreased to 22.8% (95% CI, 21.0–24.7) and 14.5% (95% CI, 12.5–16.7), respectively. Probable medication-overuse headache was identified in 1.0% of pupils (95% CI, 0.7–1.5) under both approaches. Female sex was independently associated with migraine (original approach: adjusted odds ratio [aOR], 1.6; 95% CI, 1.4–1.9; modified approach: aOR, 1.5; 95% CI, 1.2–1.8). HY was reported by 16.4% (95% CI: 14.5–18.5) of all participants. Headache disorders are highly prevalent among Vietnamese adolescents, affecting more than three-quarters of high school pupils. Migraine was associated with female sex. These findings highlight the need for improved awareness, early recognition, and appropriate management of headache disorders in school and healthcare settings in Vietnam.