Headache prevalence and attributed burden among children and adolescents in Türkiye: a re-analysis of data from a national cross-sectional schools-based study

Background Twelve years ago, in a nationwide survey of headache among children (aged 6–11 years) and adolescents (12–17) in Türkiye, many participants reported mild headache of usual duration < 1 h. Recognising that the characteristics of adult headache disorders might be undeveloped among young people, we introduced a new diagnostic category of “undifferentiated headache” (UdH). Here, informed by subsequent studies in other countries, we use a modified definition of UdH, re-analysing the prevalence data alongside those regarding attributed burden. The purposes were to inform national health and educational policies, and to contribute to understanding of headache in young people. Methods Pupils in 31 nationally representative schools completed the child and adolescent versions of the structured HARDSHIP questionnaire in class under supervision. Headache diagnoses followed ICHD-3, except for UdH (now defined as mild or moderate headache lasting < 1 h). Burden enquiries were in multiple domains (symptoms, medication use, impaired participation in school and other activities, parental work loss, emotional impact and quality of life [QoL]), with timeframes of 4 weeks and 1 day (headache yesterday). Results One-year headache prevalence (age- and gender-adjusted) was 66.1%. UdH was the most common headache type (31.3%), followed by migraine (20.4%) and tension-type headache (TTH) (9.7%). Headache on ≥ 15 days/month (H15+) was reported by 4.3%, but probable medication-overuse headache (pMOH) by only 0.8%. Migraine, pMOH and other H15 + were more prevalent among females, TTH among males. All headache types were more prevalent among adolescents. On all measures, pMOH was the most burdensome headache at individual level. Among episodic headaches, migraine was consistently the most burdensome, UdH the least. Except for pMOH, half or fewer of headache days were medicated. Measures of impaired participation, emotional impact and QoL clearly distinguished the headache types from each other. Conclusions Diagnostic difficulties among young people with headache remain only partially resolved, but our diagnostic approach, with these modified criteria for UdH, successfully separated participants into categories describing, subjectively, very clearly different headaches. UdH was the most common (47% of all headaches) but least burdensome headache among these age groups. While a worrying proportion (4.3%) reported H15+, medication overuse was uncommon (0.8%).