Undifferentiated headache: broadening the approach to headache in children and adolescents, with supporting evidence from a nationwide school-based cross-sectional survey in Turkey

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dc.authorid0000-0003-2253-3767
dc.authorid0000-0002-8340-6641
dc.authorid0000-0003-2866-4004
dc.authorid0000-0002-2861-2418
dc.authorid0000-0002-6552-4193
dc.authorid0000-0001-7358-4842
dc.authorid0000-0003-1382-1978
dc.authorscopusid7003588519
dc.authorscopusid55883039500
dc.authorscopusid16246835900
dc.authorscopusid56462513600
dc.authorscopusid36708802800
dc.authorscopusid6504530058
dc.authorscopusid24558887300
dc.authorwosidWöber, Christian/I-3574-2019
dc.authorwosidOzdemir, Yeliz Bahar/AAT-3595-2020
dc.authorwosidUygunoglu, Ugur/S-9141-2016
dc.authorwosidSiva, Aksel/A-5132-2016
dc.authorwosidDemir, Caner Feyzi/AAO-2045-2021
dc.contributor.authorWoeber, Christian
dc.contributor.authorWöber Bingöl, Çiçek
dc.contributor.authorUludüz, Derya
dc.contributor.authorAslan, Tuna Stefan
dc.contributor.authorUygunoğlu, Uğur
dc.contributor.authorTüfekçi, Ahmet
dc.contributor.authorSteiner, Timothy J.
dc.contributor.authorAlp, Selen İlhan
dc.date.accessioned2022-05-11T14:40:17Z
dc.date.available2022-05-11T14:40:17Z
dc.date.issued2018
dc.departmentFakülteler, Tıp Fakültesi, Dahili Tıp Bilimleri Bölümü, Nöroloji Ana Bilim Dalı
dc.description.abstractBackground: Headache is a leading disabler in adults worldwide. In children and adolescents, the same may be true but the evidence is much poorer. It is notable that published epidemiological studies of these age groups have largely ignored headaches not fulfilling any specific set of ICHD criteria, although such headaches appear to be common. A new approach to these is needed: here we introduce, and investigate, a diagnostic category termed undifferentiated headache (UdH), defined in young people as recurrent mild-intensity headache of <1 h's duration. Methods: We conducted a nationwide cross-sectional survey in 31 schools in six regions of Turkey selected by mixed convenience-based and purposive modified cluster-sampling. A validated, standardised self-completed structured questionnaire was administered by a physician-investigator to entire classes of pupils aged 6-17 years. Results: Of the identified sample of 7889 pupils, 7088 (89.8%) participated. The 1-year prevalence of UdH was 29.2%, of migraine (definite and probable) 26.7%, and of tension-type headache (TTH) (definite and probable) 12.9%. UdH differed with respect to almost all headache features and associated symptoms from both migraine and TTH. Burden of headache and use of acute medication were lower in UdH than in migraine and TTH. Headache yesterday was less common in UdH than migraine (OR 0.32; 95% CI 0.28-0.37) and TTH (OR 0.64; 95% CI 0.56-0.77). Quality of life (QoL) was better in UdH (33.6 +/- 5.2) than in migraine (30.3 +/- 5.6; p < 0.001) and TTH (32.4 +/- 5.3; p < 0.001), but worse than in pupils without headache (35.7 +/- 4.7; p < 0.001). Conclusions: This large nationwide study in Turkey of pupils aged 6-17 years has shown that many children and adolescents have a headache type that does not conform to existing accepted diagnostic criteria. This new diagnostic category of presumably still-evolving headache (undifferentiated headache) is common. UdH differs in almost all measurable respects from both migraine and TTH. Although characterised by mild headaches lasting < 1 h, UdH is associated with significant adverse impact on QoL. Longitudinal cohort studies are needed to evaluate the prognosis of UdH but, meanwhile, recognition of UdH and its distinction from migraine and TTH has implications for epidemiological studies, public-health policy and routine clinical practice.
dc.identifier.doi10.1186/s10194-018-0847-1
dc.identifier.issn1129-2369
dc.identifier.issn1129-2377
dc.identifier.pmid29484508
dc.identifier.scopus2-s2.0-85042664448
dc.identifier.scopusqualityQ1
dc.identifier.urihttps://doi.org/10.1186/s10194-018-0847-1
dc.identifier.urihttps://hdl.handle.net/20.500.11776/8928
dc.identifier.volume19
dc.identifier.wosWOS:000426499700001
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.institutionauthorAlp, Selen İlhan
dc.language.isoen
dc.publisherBmc
dc.relation.ispartofJournal of Headache and Pain
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectHeadache
dc.subjectUndifferentiated headache
dc.subjectMigraine
dc.subjectTension-type headache
dc.subjectHeadache yesterday
dc.subjectBurden of headache
dc.subjectQuality of life
dc.subjectChildren
dc.subjectAdolescents
dc.subjectPopulation-based study
dc.subjectNationwide
dc.subjectTurkey
dc.subjectGlobal Campaign against Headache
dc.subjectTension-Type Headache
dc.subjectGlobal Burden
dc.subjectClinical Characteristics
dc.subjectSystematic Analysis
dc.subjectPrevalence
dc.subjectDisability
dc.subjectMigraine
dc.subjectInjuries
dc.subjectDiseases
dc.subjectSchoolchildren
dc.titleUndifferentiated headache: broadening the approach to headache in children and adolescents, with supporting evidence from a nationwide school-based cross-sectional survey in Turkey
dc.typeArticle

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