Primary headache epidemiology in children and adolescents: a systematic review and meta-analysis

European Headache Federation School of Advanced Studies (EHF-SAS), Agnese Onofri, Umberto Pensato, Chiara Rosignoli, William Wells-Gatnik, Emily Stanyer, Raffaele Ornello, Hui Zhou Chen, Federico De Santis, Angelo Torrente, Petr Mikulenka, Gabriele Monte, Karol Marschollek, Marta Waliszewska-Prosół, Wietse Wiels, Deirdre M Boucherie, Dilara Onan, Fatemeh Farham, Linda Al-Hassany, Simona Sacco

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)
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INTRODUCTION: Headache is the most prevalent neurological manifestation in adults and one of the leading causes of disability worldwide. In children and adolescents, headaches are arguably responsible for a remarkable impact on physical and psychological issues, yet high-quality evidence is scarce.

MATERIAL AND METHODS: We searched cross-sectional and cohort studies in Embase, Medline, Web of Science, and Cochrane databases from January 1988 to June 2022 to identify the prevalence of headaches in 8-18 years old individuals. The risk of bias was examined with the Joanna Briggs Institute (JBI) scale. A random-effects model was used to estimate the pooled prevalence of pediatric headache. Subgroup analyses based on headache subtypes were also conducted.

RESULTS: Out of 5,486 papers retrieved electronically, we identified 48 studies that fulfilled our inclusion criteria. The pooled prevalence of primary headaches was 11% for migraine overall [95%CI: 9-14%], 8% for migraine without aura (MwoA) [95%CI: 5-12%], 3% for migraine with aura (MwA) [95%CI:2-4%] and 17% for tension-type headache (TTH) [95% CI: 12-23%]. The pooled prevalence of overall primary headache in children and adolescents was 62% [95% CI: 53-70%], with prevalence in females and males of 38% [95% CI: 16-66%] and 27% [95% CI: 11-53%] respectively. After the removal of studies ranked as low-quality according to the JBI scale, prevalence rates were not substantially different. Epidemiological data on less common primary headaches, such as trigeminal autonomic cephalalgias, were lacking.

CONCLUSION: We found an overall remarkably high prevalence of primary headaches in children and adolescents, even if flawed by a high degree of heterogeneity. Further up-to-date studies are warranted to complete the picture of pediatric headache-related burden to enhance specific public interventions.

Original languageEnglish
Article number8
JournalJournal of Headache and Pain
Issue number1
Publication statusPublished - 14 Feb 2023


  • Male
  • Adult
  • Female
  • Humans
  • Child
  • Adolescent
  • Cross-Sectional Studies
  • Headache/epidemiology
  • Tension-Type Headache/epidemiology
  • Migraine with Aura
  • Migraine without Aura
  • Prevalence


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