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DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY

REVIEW

Prevalence of headache and migraine in children and adolescents:
a systematic review of population-based studies
ISHAQ ABU-ARAFEH 1 ,2 | SHEIK RAZAK 2 | BASKARAN SIVARAMAN 2 | CATRIONA GRAHAM 3
1 Fraser of Allander Neurosciences Unit, Royal Hospital for Sick Children, Glasgow, UK. 2 Department of Paediatrics, Stirling Royal Infirmary, Stirling, UK. 3 Epidemiology and
Statistics Core, Wellcome Trust Clinical Research Facility, University of Edinburgh, Western General Hospital, Edinburgh, UK.
Correspondence to Dr Ishaq Abu-Arafeh at the Department of Paediatrics, Stirling Royal Infirmary, Livilands, Stirling FK8 2AU, UK. E-mail: iabu-arafeh@nhs.net

PUBLICATION DATA

AIM The aim of this study was to review systematically the prevalence of headache and migraine

Accepted for publication 20th July 2010.
Published online 28th September 2010.

in children and adolescents and to study the influence of sex, age, and region of residence on
the epidemiology.
METHOD We systematically searched the literature in electronic databases to cover the period
between 1 January 1990 and 31 December 2007. We assessed and included population-based
studies on epidemiology of headache and migraine in children and adolescents if they fulfilled the
following criteria: (1) reporting on unselected childhood population; (2) reliable methods of data
collection using a questionnaire or face-to-face interviews; (3) using the International Headache
Society’s (IHS) criteria (1988 or 2004) for the diagnosis of migraine; and (4) provision of sufficient
and explicit data for analysis. We used Excel, Stata, and Confidence Interval Analysis software.
RESULTS We identified and analysed 50 population-based studies reporting the prevalence of
headache and ⁄ or migraine in children and adolescents (<20y). The estimated prevalence of headache over periods between 1 month and lifetime in children and adolescents is 58.4% (95% confidence interval [CI] 58.1–58.8). Females are more likely to have headache than males (odds ratio
[OR] 1.53, 95% CI 1.48–1.6). The prevalence of migraine over periods between 6 months and lifetime is 7.7% (95% CI 7.6–7.8). Females are more likely than males to have migraine (OR 1.67, 95%
CI 1.60–1.75). Regional differences in prevalence of migraine, though statistically significant, may
not be of clinical significance. The change in the IHS’s criteria for the diagnosis of migraine was
not associated with any significant change in the prevalence of migraine.
INTERPRETATION This study confirms the global high prevalence of headache and migraine in
children and adolescents. Sex, age, and regional differences are evident.

ABBREVIATIONS

IHS
International Headache Society
CI
Confidence Interval
ICHD-II International Classification of
Headache Disorders, second edition
OR
Odds Ratio

Childhood headache has an important adverse impact on the
child and the family, as shown in many studies, including a
recent review.1 Therefore an accurate estimate of the true
prevalence derived from all published world literature will
help in assessing the magnitude of the problem, streamlining
resources in improvement of diagnosis and treatment, and
reducing its burden.
The prevalence of childhood headache and migraine has
been reported from across the world with widely variable estimates of prevalence. Since the publication of the International
Headache Society’s (IHS) Classification and Diagnosis of
Headache Disorders2 in 1988 and the second edition of the
International Classification of Headache Disorders3 in 2004
(ICHD-II), there have been several published studies that
share common methods and criteria for the diagnosis of
migraine. These allow a systematic review of the world literature, despite some inevitable minor variations in methods such
as the use of a questionnaire, face-to-face interviews, or both
1088 DOI: 10.1111/j.1469-8749.2010.03793.x

in collecting data, point-in-time prevalence, and reporting on
different age groups within the childhood population. A
degree of heterogeneity is, therefore, an inherent feature of
such analysis and is addressed in this study by maintaining its
focus on a few questions relating to prevalence. The large
number of children and adolescents in the studies is likely to
minimize the effects of such minor differences.

METHOD
A protocol for this study was developed by paediatricians with
interest in headache epidemiology and supported by a statistician. A quantitative summary of published data as described
by Blattner et al.4 is considered an appropriate method for
analysing the epidemiology of headache and migraine in children. We based our data collection, analysis, and reporting on
the methods and style of Cochrane databases, and in keeping
with the ‘preferred reporting items for systemic reviews and
meta-analysis: the PRISMA statement’.5
ª The Authors. Journal compilation ª Mac Keith Press 2010

Quality assessment and inclusion criteria We assessed each paper to eliminate any selection bias. We used the search command (prevalence or epidemiology) and (headache or migraine) and (children or adolescents) for publications between 1 January 1990 and 31 December 2007.42 Isik et al.16 Carlsson17 Antoniuk et al. Review 1089 .24 Al Jumah et al. and regional influences on the prevalence of headache in children over variable periods of time. and cross-referenced recent review articles on childhood headache and migraine.43 Milovanovic44 Unalp et al. but not the results.25 Fichtel and Larsson26 Ho and Ong27 Shivpuri et al.37 Siddiqui et al.46 Total 1998 1999 1999 2001 Germany Italy Brazil Sweden Brazil Finland United Arab Emirates Finland Finland Poland Holland 8–9 6–7 6–19 10–17 3580 1290 2353 2358 1306 (37) 725 (56) 1759 (75) 2145 (91) 2002 2002 2003 2003 2004 2004 2005 2005 2005 2006 Saudi Arabia Sweden Singapore India Sweden Norway Qatar Turkey Germany Jordan 6–18 15–16 10–19 11–15 7–15 13–18 6–17 8–16 4–18 6–14 1181 792 205 1305 1371 5847 851 5562 749 1120 588 (50) 258 (33) 174 (85) 255 (20) 614 (45) 4535 (78) 706 (83) 2739 (49) 453 (61) 269 (24) 2006 Iran 6–13 2226 691 (31) 2006 2006 2006 2006 2007 2007 2007 2007 2007 2007 2007 Turkey Norway Pakistan Canada Turkey Sweden Germany Turkey Serbia Turkey Japan Reference 12–17 7–12 12–20 9–13 9–17 9–15 7–14 6–13 7–12 14–18 12–15 Headache n (%) Males’ Total headache males n (%) Year of publication Country 2418 738 266 588 2108 (87) 147 (20) 234 (88) 135 (23) 2417 707 274 556 1077 934 (87) 1281 573 407 272 (48) 98 (24) 608 385 750 686 2811 236 2985 135 (18) 269 (39) 1940 (69) 191 (81) 1378 (46) 555 685 3036 615 2577 2387 1245 (52) 1244 561 (45) 1143 2126 1225 (58) 1211 1035 (86) 614 521 (85) 597 495 386 (78) 7721 6431 (83) 3875 3084 (80) 3846 1903 1122 (59) 975 486 (60) 928 5474 2927 (54) 2770 1440 (52) 2704 2228 700 (31) 1134 336 (30) 1094 1259 413 (33) 2384 1090 (46) 1018 367 (36) 1366 6472 3872 (60) 80 876 47 266 (58) 26 798 15 440 (58) 26 953 2189 (91) 198 (28) 212 (77) 146 (26) Point Method reference Q and I 12mo Q I I and E Q Lifetime 12mo 12mo Lifetime 12mo Q and I 12mo I and E 12mo 12mo 1222 (95) 316 (52) Q 160 (42) Q Q 117 (21) Q 345 (50) Q and I 2586 (85) Q and I 532 (87) Q and I 1361 (53) Q and I Q 12 Current Lifetime Lifetime 12mo 12mo 12 Lifetime 3mo 12mo 12mo 684 (60) Q and I Q 514 (86) Q and I 12mo 1mo Lifetime 3350 (87) 636 (69) Q 1487 (55) Q 364 (33) Q Q and I 723 (53) Q Q 18 035 (67) Lifetime 3mo 6mo 12mo Q.14 Raieli et al.45 Ando et al. E. on their validity for inclusion. Embase.29 Zwart et al. independently. I. and Google Scholar. age.30 Bessisso et al.11 Kristja´nsdo´ttir and Wahlberg12 Kristja´nsdo´ttir and Wahlberg12 Abu-Arafeh and Russell13 Pothmann et al. • It assesses the influence of different diagnostic criteria on the prevalence of migraine. A strict adherence to the inclusion criteria with the focus on the What this paper adds • It allows better understanding of the epidemiology of headache and migraine in children and adolescents.28 Laurell et al. questionnaire.32 Roth-Isigkeit et al. The first three authors agreed after reading all the papers.15 Barea et al. (1) Population-based studies of randomly selected participants published between 1 Table I: Summary of population-based studies on the prevalence of headache in children and adolescents Females’ Total headache females n (%) Age range (y) Total King and Sharpley10 Mortimer et al.40 Brun Sundblad et al.38 van Dijk et al.31 Bugdayci et al. examination. research methods.22 Krasnik23 Bendell-Hockstra et al.39 Aykol et al. interview.36 Lundqvist et al. was followed. • It quantifies the effects of sex.18 Aromaa et al. We also searched Cochrane databases. • To our knowledge. no similar study has been published.19 Bener et al.Literature search We searched the literature on the epidemiology of headache and migraine in children using PubMed.21 Anttila et al. Studies were included if they fulfilled the following criteria.41 Kroner-Herwig et al.33 Alawneh and Bataineh34 Ayotallahi and Khorsavi35 Karli et al.20 1990 1992 1993 Australia UK Iceland 10–18 3–11 11–12 900 1083 1016 513 (57) 409 (38) 533 (53) 549 512 307 (56) 256 (50) 534 498 Q 294 (55) I and E 272 (55) Q 12mo Lifetime 1993 Iceland 15–16 1124 567 (50) 572 241 (42) 547 327 (60) Q Lifetime 1994 UK 5–15 1754 1166 (67) 1994 1995 1996 1996 1998 1998 1998 8–16 11–14 10–18 7–16 10–14 6 6–14 4835 1445 538 1144 460 968 1159 4297 (89) 345 (24) 446 (83) 281 (25) 414 (90) 204 (21) 428 (37) Metsahonkala et al.

8) Lifetime 12mo 12mo Lifetime 12mo 12mo Lifetime 12mo 12mo Lifetime Lifetime Lifetime 12mo 12mo 12mo 12mo 6mo 12mo 22 (2.7) Q Q and I 591 27 (4.5) 84 (7.3) Turkey Thailand 14–18 12–15 ICHD-II ICHD-II 2384 1789 510 (21.6) Q and I 668 14 (2.8) 1500 2081 1305 8359 205 5562 1371 2490 5847 851 7942 7833 7658 1066 1120 145 (11.3) Q and I 27 (10.0) Q 273 (9.1) 738 20 (2.56 2001 2005 Wang et al.30 31 2005 Bessisso et al.9) 3781 3681 3581 1171 24 (4.8) 945 111 (11.9) 426 (28.7) 32 (2.8) 2418 196 (8.1) I 78 (14.5) 4152 204 (4.50 2001 Kong et al.9) 413 (5.11 Abu-Arafeh and Russell13 Pothmann et al. The starting date was based on the fact that no population-based studies were published before this date that used the 1988 IHS’s criteria for the diagnosis of migraine.28 2003 Fuh et al.0) 1983 114 (5.5) 92 (5.9) Q 23 (3. and examination were provided.8) 1266 85 (6.40 2007 Bigal et al.1) 526 (6.0) Q and I 303 (11.7) IHS-I.7) 266 26 (9. and prevalence by sex.2) 573 37 (6. Corresponding authors were contacted for clarifications if an ambiguity was detected but could not be resolved.15 Barea et al.53 2003 Ho and Ong27 54 2003 Ozge et al.9) 4077 241 (5.7) 277 (6. Studies reporting on populations under 20 years of age were included to maximize the inclusion of relevant studies.0) 43 (3.20 Year of publication Country Age range (y) Criteria Total Migraine n (%) 1992 1994 UK UK 3–11 5–15 IHS-I IHS-I 1083 1754 40 (3. E. analysis and Table II: Summary of population-based studies on the prevalence of migraine in children and adolescents Reference Mortimer et al.8) 9624 481 (5.5) 7–12 IHS-IR 1259 41 (3.7) 159 (9. International Classification of Headache Disorders (2004).9) Q and I Q and I 2353 3509 198 (8.2) 1194 1759 1159 1750 144 (12. interview.42 2007 Milovanovic et al.4) 1055 1134 34 (3.48 49 Split and Neuman 1999 2000 Lu et al.2) Q and I Lifetime and E 6472 313 (4.3) 3126 203 (6. Collection of data From each study we collected data on the year of publication. (2) Reporting on a population of children and adolescents. number of participants with effects and the prevalence of headache and ⁄ or migraine.9) 2417 707 272 1111 336 (13.0) 55 104 5340 (9.4) 127 (7.1) 1994 1995 1996 1997 1998 German 8–16 Italy 11–14 Brazil 10–18 USA 5–13 United Arab 6–14 Emirates Poland 6–19 Greece 4–15 IHS-I IHS-I IHS-I IHS-I IHS-I 4835 1445 538 2572 1159 IHS-I IHS-I Poland Taiwan Hong Kong Saudi Arabia Iran India Taiwan Singapore Turkey Sweden Turkey Norway Qatar Taiwan Taiwan Taiwan Finland Jordan 1999 Krasnik23 1999 Mavromichalis et al. 2002 Shivpuri et al.5) Q 131 228 10 093 (7. questionnaire.7) 2811 134 (4.55 2004 Zwart et al.4) Q and E 163 (7.7) 2985 273 (9.8) 410 (7.8) 567 (7.January 1990 and 31 December 2007.3) 752 (9.8) Q and I 12mo 2 (2.1) Q 12mo 137 (16.16 Lee and Olness47 Bener et al.8) 1115 99 (8.0) Q 328 (8. 2007 Visudtibhan et al. (6) Appropriate statistical methods were used for analysis.25 52 2002 Ayatollahi et al.2) 533 (6.3) 411 (7. Q.43 2007 Akyol et al.4) 114 (10.9) 576 (10.1) 852 85 (10. 2004 Zencir et al. examination.3) I and E 120 (9.6) 44 (3. sample size.9) 326 (9.7) Q 450 (11.7) 1178 (6.4) 248 (13.44 45 2007 Unalp et al. 29 2004 Laurell et al.0) 1094 3846 9090 Q and I 40 (3.14 Raieli et al.7) Q 114 (6. 52: 1088–1097 .2) 685 67 (9. 2007 Isik et al.7) ICHD-II ICHD-II ICHD-II ICHD-II ICHD-II 2387 2228 7721 18714 5474 341 (14. (5) Clear description of the methods of data collection such as the use of a questionnaire.4) 219 (6. 1090 Developmental Medicine & Child Neurology 2010.9) 608 1868 555 107 4 (3. I.7) Q and I 700 (7.2) Q and I 135 (11.1) 1018 140 (13.51 2002 Al Jumah et al.9) Japan 12–15 ICHD-II 549 888 Females’ Total migraine females n (%) 16 (2. (4) The diagnosis of migraine was based on the IHS criteria and classification of 1988 or 2004. the methods of assessment of headache and migraine.0) 220 (8. the geographical origin of the study.5) I and E 12mo 85 (9.3) 74 (3.0) Q and I Q and I 226 (6.57 2006 Alawneh and Bataineh34 2006 Ayatollahi and Khorsavi35 38 2006 Karli et al.9) 74 (8. International Headache Society’s Classification and Diagnosis of Headache Disorders (1988).4) 151 (11.46 Total Iran Turkey Turkey Turkey USA Germany 15–19 13–15 6–13 6–18 11–18 11–15 13–15 10–19 8–16 7–15 11–18 13–18 6–17 12–14 12–14 12–14 7 6–14 6–13 Point Method reference 534 866 532 (11.58 2007 Kroner-Herwig et al.9) 222 (8.0) 53 (9. face-to-face interview.1) Q IHS-I 2226 38 (1.0) 3875 302 (7. The data were tabulated for ease of comparison.1) I and E Q and I 16 (1. 1999 2005 Wang et al.5) 750 67 (8.56 2002 2005 2006 Anttila et al. IHS-IR.59 2007 Ando et al.8) Q and I 84 (12.8) Q and I Q and I 47 (7.3) 6 (2. (3) Descriptive data were available or easily reproducible from the original article.8) 3346 110 (3.8) 98 2577 686 1224 3036 4161 187 (4.1) Q and I 12mo 12mo Life time 12mo 6mo 1366 844 370 (27.0) 101 (11.3) Q and I 12mo IHS-I IHS-I IHS-I IHS-I IHS-I IHS-I IHS-I IHS-I IHS-IR IHS-IR IHS-I Self-report IHS-I IHS-I IHS-I IHS-I ICHD-II IHS-1 2352 4064 2120 1181 511 (21. The year 2007 was the last full year before the beginning of our work on this project. age range of the participants. International Headache Society’s Classification and Diagnosis of Headache Disorders – Revised. ICHD-II.3) 12–17 6–13 9–17 12–19 7–14 Serbia Males’ Total migraine males n (%) 54 (4.8) 11 (0.7) 55 110 3283 (6. 56 Wang et al.

6. 1) and migraine (Fig. The OR for prevalence of headache in females compared with males is 1. 3. The reported prevalence of headache and the calculated 95% CIs in all studies are shown in Fig. as recommended by Begg and Berlin. was investigated. (3) The role of the diagnostic criteria on the prevalence of migraine was also explored. nine on genetics of headache. Prevalence of headache was reported for children complaining of headache occurring over lifetime or the past 12. and sex differences if applicable.6 Assessment of heterogeneity and subgroup analysis Differences between studies were explored to identify heterogeneity. Google Scholar.8%). Twenty-two studies provided the sex-specific prevalence of headache.9 RESULTS The search of PubMed. 4.14–59 All studies collected information from unselected childhood populations using a questionnaire with or without an interview and examination. We used Confidence Interval Analysis software (published by the British Medical Journal Publishing Group7) and analysed the differences between the percentages by a v2 test. Therefore we comparatively assessed the prevalence of headache and migraine in studies reporting over a short period (<6mo) with prevalence in those reporting over a long period (at least 6mo). method of data collection. Only 50 articles were found to fulfil the search criteria for population-based studies of headache and ⁄ or migraine in childhood. Publication bias The informal funnel graph. Meta-analysis of the sex differences in prevalence of headache using Stata to calculate OR and the 95% CI is shown in Fig. PubMed produced most of the papers except for five articles identified by Google Scholar. 12 on the prognosis of headache. These included the following areas.to show similarities as well as differences (heterogeneity). The overall calculated prevalence of headache (at any point in time) in a total population of 80 876 children is 58. and age range of childhood populations are included.8.1–58.4% with a narrower 95% CI (58. Heterogeneity between studies for point-in-time prevalence. It was possible to exclude 213 articles: 40 were review articles. We also used Excel and Stata for the odds ratio (OR) with 95% confidence intervals (CIs) where appropriate. It is feasible that these variables may constitute major differences and may provide heterogeneous data. Figure 2: Publication bias test for the sample size (y axis) versus prevalence of migraine in each study (x axis). Figure 1: Publication bias test for the sample size (y axis) versus prevalence of headache in each study (x axis). Analysis of the prevalence of migraine with and without aura was not possible in these studies and is not presented here. however. ranging from 1 month to lifetime.6 shows the typical pyramid-shaped graph with tapering for prevalence of headache (Fig.48–1. methods of data collection. diagnostic criteria of migraine. We summarize the findings of each study in Tables I and II. and 34 on headache comorbidities. number of cases. number of participants in the study population. in nine studies no reference was made to the period of time. We assessed the prevalence of migraine in young children (<14y) compared with that in all children and adolescents up to the age of 20 years. country of origin. 2). 28 prevalence studies on adult populations. 3 and demonstrate the variability in prevalence among studies. Review 1091 .60). or 1 month. (4) We also investigated and compared the possible influences of racial or geographical origin. We separately analysed the prevalence of migraine in studies using the IHS criteria for the diagnosis of migraine (1988) and in those using the ICHD-II. one case report. and Embase produced 258 articles.10–12. Publication bias We tested for publication bias by using the informal funnel graph as recommended by Begg and Berlin. showing year of publication. (2) Differences in prevalence between age groups were explored. 38 on headache diagnosis or the prevalence of headache among specific patients groups. nine on chronic daily headache. 21 clinic series. (1) The reported prevalence of headache and migraine over different periods of time. Cochrane databases.53 (1. 21 on headache treatment. Statistical analysis We show the raw data in tables and our assessments in figures. Analysis included graphic data summary and Forest Plot. prevalence. Prevalence of headache Thirty-seven population-based studies (Table I) provided 38 sets of data and reported on the prevalence of headache in children under the age of 20 years.

52: 1088–1097 3.3% (p<0.60–1.4–3. p<0.2). the difference is 2. The cumulative analysis showed the overall prevalence of migraine in children and adolescents is 7.001).2).8).7). Eleven studies used the ICHD-II of 2004. which is 9. gives a value of 1.01). The trend in prevalence is shown by the vertical line.4).3 Two studies used revised criteria.001). Role of diagnostic criteria on the prevalence of migraine Twenty-one studies used the 1988 IHS criteria. The diagnosis of migraine was made on the application of the IHS’s criteria of 1988 or the ICHD-II.9) and in males 6.8–6. as shown in Fig.7% compared with 6. Twenty-nine studies provided data on the prevalence of migraine in females (one study reported on females only). the difference is 2. giving a total number of children of 68 954 and a prevalence of 7. the difference is 1092 Developmental Medicine & Child Neurology 2010. p<0.7% (95% CI 7.5–2. The prevalence of migraine among females is 7.4–9.8–6. which is significantly lower than the prevalence of migraine in all females under the age of 20 years. Prevalence of migraine Thirty-five studies (Table II) provided 37 sets of data of the prevalence of migraine in people under the age of 20 years.5% (95% CI 7. Role of age on prevalence of migraine Table III shows the population studies reporting prevalence of migraine in children (£14y). The overall prevalence of migraine in female children and adolescents is 9. Meta-analysis of the OR for prevalence of migraine in females.9. Similarly the prevalence of migraine in males of 14 years of age or under is 4.6–7.9.7–7.0% (95% CI 5. giving . 6.67 (95% CI 1.7% (95% CI 3.7% (95% CI for difference 2. 5. Subgroup analysis Role of sex on prevalence of migraine Twenty-eight population-based studies provided data on the prevalence of migraine among males. The reported prevalence figures of migraine over a minimum period of 3 months (and 95% CIs) are shown in Fig.0% in males of all ages under 20 years (95% CI 5.Figure 3: Prevalence and 95% confidence interval of headache in population-based studies.7%.75).2.0% (95% CI 6.3–7.7% (95% CI 9.

the high frequency of headache and migraine. degrees of freedom=3. the use of the first or second editions of the IHS criteria for the diagnosis of migraine are shown in our analysis Review 1093 . There is evidence of a statistically significant difference (v2=173.0). capturing as much homogeneity among the subgroups as possible by assessing one variable at a time. especially when some or all of the epidemiological studies are observational in nature and may have disparate results. We realize the difficulties that are inherent with systemic reviews and meta-analyses of published literature. although it may be of clinical value for individual patients. a total number of children of 64 985 and a prevalence of 7.9 We therefore identified and managed the differences between studies as appropriate and performed subgroup analysis.12. The difference in prevalence between the two sets of criteria is not statistically significant. it is still possible to make reasonable conclusions about the appropriateness of the methods we used. DISCUSSION Study methods The use of published literature is unlikely to carry any selection bias as most papers presented at meetings and conferences were subsequently published in full and are included. Point-in-time prevalence of migraine No evidence of a significant difference was noted between studies that reported on prevalence of migraine or headache over long periods of time (at least 6mo or no report on the time period) compared with the overall prevalence (Table V). The prevalence figures in the pooled data.6–8. as described by Greenland. though. produced narrow 95% CIs that should be read with caution as they should not hide the differences in the individual studies. Role of geographical background on prevalence of migraine The prevalence of migraine by geographical region is illustrated in Table IV. p<0. However. has minimized any such differences and proved of little consequence in the overall analysis. Also.Figure 4: Odds ratio and 95% confidence interval for prevalence of headache in female children and adolescents. particularly the inclusion of the whole age spectrum of children and adolescents up to 20 years. It is not possible to assess the quality of methods and data in studies that were neither published nor presented. as shown in several population-based studies. It is not possible to assess the role of any possible racial influences on the prevalence of migraine from the information given in the studies.8% (95% CI 7. Despite these limitations of our data. the heterogeneity of the studies in reporting prevalence against different points in time may seem a significant difference.001). Similarly.

9) 241 (5.7) 534 707 1055 1094 591 1111 3781 3681 3581 16 135 24 (4.6) 120 (9.1) 1136 (7.6 Prevalence of headache Despite the wide differences in the reported prevalence of headache in different studies in children and adolescents.Figure 5: Prevalence and 95% confidence interval of migraine in population-based studies. The trend in prevalence is shown by the vertical line.9) 326 (9.1) 40 (3.5) 23 (3. 52: 1088–1097 reporting.0) 328 (8. but probably of no clinical significance on the prevalence of migraine.56 2001 Wang et al.0) 14 (2.9) 831 (4.9) 187 (4. for which subgroup analysis has proved a very useful tool. The validity of our study and the analysis of the data were assessed against the checklist of items as suggested by a recent publication on research methods and 1094 Developmental Medicine & Child Neurology 2010.44 Lee and Olness47 Wang et al.56 1999 Wang et al.43 Milovanovic et al.0) to be of some effect.5) 204 (4.1) 99 (8.7) 16 (1. Table III: Prevalence by sex of migraine in children under the age of 14 years Reference Mortimer et al.3) 22 (2.9) 20 (2.4) 34 (3.9) 226 (6.7) 27 (4. Pooled grouping has also provided data on specific population characteristics.15 Ayatollahi and Khorsavi35 Isik et al.11 Raieli et al.56 2002 Total Age (y) Total males Males’ migraine n (%) Total females Females’ migraine n (%) 3–11 11–14 6–13 6–13 7–12 5–13 12–14 12–14 12–14 549 738 1171 1134 668 1115 4161 4152 4077 17 765 16 (2.5 Analysis for publication bias using the informal graphic method was reassuring and conforms to accepted recommendations. a .

Visudtibhan et al.45.91 Middle East Far East USA clear and reliable estimate of the magnitude of the problem has emerged. and may have attacks of variable frequency.70 6. Raieli et al.60 38 829 3374 8. Zencir et al.58 46 580 3888 8. Ho and Ong27. Laurell et al.29.51. Ayatollahi et al.15. This result will help public health Review 1095 . Wang et al. Anttila et al. Ozge et al.30.69 8. It does not mean that 60% of children have headache at any given point in time. but it confirms the high prevalence of headache in children.52. Abu-Arafeh and Russell13. Bessisso et al.10–8.95 21 286 1400 6.Figure 6: Odds ratio and 95% confidence interval for prevalence of migraine in female children and adolescents.34.57. Split and Neuman49 Mavromichalis et al.36. Krasnik23.42 Bener et al. Isik et al.31 Alawneh et al. Al Jumah et al. This analysis shows that around 60% of children are prone to headache. Bigal et al.54.35 8.41–8. Milovanovic et al.97 39 486 2646 6.45–6. Zwart et al. Karli et al.40.43.28 Lee and Olness47.56.53. over periods varying from 3 months to lifetime.20.25. Ayatollahi and Khorsavi35. Akyol et al.46 Lu et al. Such a high prevalence may not surprise many researchers and clinicians. Kroner-Herwig et al. Table IV: Geographical prevalence rates of migraine Region Population studies Total Migraine Prevalence (%) 95% confidence interval Europe Mortimer et al.11. Shivpuri et al. Ando et al.14.59.44. Kong et al. Pothmann et al. Unalp et al.24–6.55.48.50.58 6. Fuh et al.

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Friedenreich C.2) 26 953 18 035 66.3) 24 282 14 520 59. 8(Suppl. Schlehofer B. Can meta-analysis be salvaged? Am J Epidemiol 1994.0% (5. Classification Committee of the International Headache Society. but it does not seem to have made a significant difference in the calculation of migraine prevalence in children and adolescents.0. J Paediatr Child Health 1990.4% (58. Int J Epidemiol 1999. 52: 1088–1097 34: 1095–101. 9.2) 55 104 5340 9. meta-analysis and pooled analysis in epidemiology. The only difference between the IHS’s diagnostic criteria of migraine of 1988 and those of ICHD-II of 2004 is the reduction in the duration of migraine attacks from a minimum of 2 to 1 hour. 10. Int J Behav Med 1994.9) 65 981 40 860 61. Tetzlaff J. CONCLUSION Headache is common across the world. Kristja´nsdo´ttir G.6–7. Cephalalgia reporting items for systemic reviews and meta-analysis: the childhood migraine in an urban general practice using ad 2008.9% (61. Muller B. 29: 3–16.2–60. Vahlquist and IHS criteria. BMJ 2009.9% (7. 28: 1–9.4) 33 177 3337 10. it is not possible to assume that the differences are due to racial background as most studies did not provide data on the racial makeup of their populations.Table V: Influences of the different time periods on prevalence of migraine and headache Migraine Headache Point prevalence >6mo Whole group >6mo Whole group Total population Migraine Prevalence (CI) Total males Migraine Prevalence (CI) Total females Migraine Prevalence (CI) 85 513 6738 7. and despite small variations in reporting across the world it is safe to state that around 8% of children and adolescents suffer from it over periods ranging from 3 months to lifetime. Blattner M.1) 31 322 1932 6. Wahlberg V. Jaron A. Invited commentary: a critical look at some ache disorders. 14. 2. 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