Prevalence of Migraine and Other Headaches in Early Puberty

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Scand J Prim Health Care 194;2: 2-32 2 Prevalence of Migraine and Other Headaches in Early Puberty by mm SILLANPM PAULA PIEKKALA Scand J Prim Health Care Downloaded from informahealthcare.com by 13.9.1.220 on 0/20/ M Sillanpiiu M Sc D: Professor of Public Health (act.

1 Scand J Prim Health Care 194;2: Prevalence of Migraine and Other Headaches in Early Puberty by mm SILLANPM PAULA PIEKKALA Scand J Prim Health Care Downloaded from informahealthcare.com by on 0/20/ M Sillanpiiu M Sc D: Professor of Public Health (act.), Department of Public Health, University of Turku, Turku, Finland. P Piekkala M D: Assistant Physician, Department of Public Health, University of Turku, Turku, Finland. ABSTRACT. A representative epidemiological study on the oaxrence of migraine and other headaches in Finnish schoolchildren years of age is presented. The investigation covered 363 pupils, accounting for W.2% of the total of 4101 mentally normal chiidren, who went to school in two big Finnish cities. There were 194 boys and 1909 girls in the study. They were given a one-page questionnaire with four questions concerning the frequency and the nature of headache in themselves and their family members. Considerable attention was paid to the wording and unambiguity of each question. The forms were filled in under the control of the homeroom teacher, whose check-up of the amers was intended to remove diserepancies between the filled-in forms and the children s complaints. For the clinically working physician, especially the general practitioner, it is worthwhile noticing that during the last 12 months not less than 6% of the leyearsld schoolchildren had suffered from headache. Headache had been less frequent in the boys (6 6) than in the girls (1%). In 10.2% of the schoolchildren migraine attacks had occurred. Again, the boys had migraine less frequently (6.%) than the girls (13.%). The combination of individual migraine factors, which occurred in one third of the cases, was unilateral pain and migraine in other family members. The figures are similar to those in another investigation of headaches in schoolchildren. KEY WORDS: Epidemiology. Migraine. Pediatric headache. School health. INTRODUCTION An approaching puberty in a school pupil seems to represent a stresss factor, which often enhances the occurrence of headaches. At the age of 13, when the pupil moves from primary to secondary school, the occurrence of headaches is particularly high (1). TO find out whether it is reasonable to think, that this age stands for the peak prevalence of headaches before the onset of puberty, an unselected population of -year-old schoolchildren were examined in order to answer the following questions: The number of pupils who had had a headache before or at the age of, the frequency of headache in individual cases, recurrence of headaches, prevalence of migraine, and prevalence of headaches in the children s families. MATERIAL AND METHODS The study was carried out in February and March 191 and concerned school pupils aged in two big Finnish cities, Tampere and Turku, the second and third biggest cities in Finland, which have a total of approximately 4000 pupils aged to 1 attending compulsory education schools (2). The two cities have some 16 OOO inhabitants each (3). In addition to the number of inhabitants, they are quite similar to each other in other respects; e.g. no significant differences in social or occupational profiles can be found. The present study concerns 363 pupils, accounting for 94.2% of the 4101 fourteen-year-olds in Tampere and Turku. There were 194 boys (0.6%) and 1909 girls (49.4%). Children who were absent from school on the day of the study, and those with varying degrees of mental subnormality and not attending school were omitted from the study. The investigation was carried out in the schools by using a one-page questionnaire with four questions designed for this particular study (Fig. 1). The questions concerned 1) the Occurrence of headache, 2) its frequency in individual cases and in their family members, 3) its paroxysmal nature, and 4) the occurrence of migraine symptoms. Considerable attention was paid to the wording and unambiguity of each question. In cooperation with the school authorities, the questionnaires were sent in advance to the home-room teachers of the classes concerned for a preliminary view. Written Scand J Primary Health Care 194; I

2 2 Report of Headache Fig. 1. Questionnaire designed for this study. Scand J Prim Health Care Downloaded from informahealthcare.com by on 0/20/ Pupil s name Sex School Date of birth N. B.! From each item please encircle that number you find accurate! 0 1. Have you had during 190 headaches which have disturbed your school attendance, home work, leizure activities or daily living? 1 never 2 once 3 two to eleven times 4 approximately once a month two or three times a month 6 approximately once a week two times a week or more but not daily daily 0 2. If you had disturbing headaches, have they been paroxysmal (episodes of pain of relatively rapid onset, the pain rapidly reaching its maximum and lasting for few hours or being gone next morning on waking up?) 1 no 2 yes 0 3. If you have had paroxysmal headaches described above, have one or more of the following items been associated (please encircle appropriate items): 1 visual symptoms immediately before or at the onset of headache 1 nausea, vomiting or both 1 has headache accurred on one side of the head only, possibly alternating from side to side in successive headache attacks 1 have mother, father, brother(s) or sister(s) suffered from headache, which has been told migraine 0 4. Have you previously had recurrent headaches, which have ceased later 1 no 2 yes, but no more 3 yes, and again recumng Scand J Primary Health Care 194; 1 THANK YOU FOR YOUR COOPERATION!

3 29 Scand J Prim Health Care Downloaded from informahealthcare.com by on 0/20/ instructions for the completion of the forms and the name of the contact person in case of difficulties were given at the same time. The wording of the forms was also reviewed by the teachers. The forms were filled in according to instructions given during the lesson by the teacher, and with the teacher s technical help if needed. The pupils had 10 minutes to fill in the questionnaires, which were then collected by the teacher. The term headache was defined as a pain in the area of the head, which handicapped the pupil s school attendance, homework, leisure activities, or daily living. By paroxysmality of the headache was meant episodes of pain with relatively sudden onset, the pain rapidly reaching its maximum and lasting for a few hours or being gone the next morning on waking up. Migraine was defined according to the definition of Vahlquist4 as headache paroxysms separated by symptom-free intervals and involving two to four of the following four symptoms: visual aura at the onset of the attack; nausea or vomiting or both; unilateral nature of the pain; and the occurrence of headache confirmed or suspected by a physician as migraine in one or more of the patient s family members. For statistical analyses X* test was applied. RESULTS Tuble I. Frequency of disturbing headache in -year-old schoolchildren in 190. During the 12 months in pupils (6%) had suffered from headaches. Boys were more frequently free from headache than girls (Table I). There was no significant difference in frequency categories between the sexes. The previous headaches, which had occurred earlier than the year 190 (cf. Fig. l), had recurred in 0% of the girls but in only 3% of the boys (Table 11), which is significant (p < 0.OOOl). Frequent headache occurred approximately equally often in the two sexes. Migraine occurred in 393 children, i.e. 10.2% of the total group of pupils (Table 111). Migraine was twice as common in girls (13.%) as in boys (6.%), which is significant (p < 0.00). There was no significant difference between the sexes as to the frequency of migraine attacks among pupils with migraine (Table IV). In most pupils, who had migraine, the frequency of attacks was rather low, being once a month or less in 60% of the cases. Table V shows the occurrence of single migraine symptoms in girls and boys, who had migraine. Migraine frequently occurred in other family members, Girls Boys Total Frequency n % n % n % No headache Less than monthly Monthly Weekly Daily Not known Total Tuble 11. Recurrence of headache in -year-old schoolchildren with previous headache. Ceased Recurrent Total Sex n % n % n % Girls Boys Total Scand J Primary Health Care 194; I

4 Scand J Prim Health Care Downloaded from informahealthcare.com by on 0/20/ 30 and pain was frequently experienced unilaterally. Nausea or vomiting were less frequently present. Visual aura, the characteristic feature of classic migraine, was noticed by 39% of the children, and less frequently in boys. There was no sex difference for the other parametres. Table VI shows the various combinations of single migraine symptoms, which occurred in girls and bys. Every third case (34%) had two factors associated with the migraine attack: Unilateral pain and migraine in another family member or members. The second and third most frequent combinations were nausea and/or vomiting plus migraine in the family Tubfe 222. OFrrence of migraine in -year-old schoolchildren in 190 (N = 363). (13%), and visual aura plus unilateral pain (12%). The three most frequent combinations of symptoms mentioned above were the ones complained of by the girls. Among the boys unilateral pain was more often combined with nausea and/or vomiting than with visual aura. Most pupils suffering from migraine (4%) had experienced a recurrence or recurrences of periods of migraine attacks without any longer symptom-free period, while one fourth (26%) had hadat least one symptom-free periods, which lasted for more than a year. There was no significant difference between the sexes. With migraine Without migraine Total Sex n % n 46 n % Girls Boys Total Tubfe 2%. Frequency of attacks in -year-old schoolchildren with migraine. Girls Boys Total Frequency n % n % n % Less than monthly Monthly Weekly 4 ia Dailv ~ ~~ ~~ Total Tuble V. Occurrence of single migraine symptoms in -year-old schoolchildren with migraine. Girls (N=263) Boys (N=130) Total (N=393) Symptom n % n % n 0 Visual aura Nausedvomiting Unilateral pain Migraine in the family Scand J Primary Health Care 194; I

5 31 Table Vf. Various combinations of single migraine symptoms in ldyear-old schoolchildren. Scand J Prim Health Care Downloaded from informahealthcare.com by on 0/20/ Girls Boys Total Combinations n % n % n % Visual aura, nausea Visual aura, unilateral pain Visual aura, migraine in the family Nausea, unilateral pain Nausea, migraine in the family Unilateral pain, migraine in the family Visual aura, nausea, unilateral pain Visual aura, nausea, migraine in the family Visual aura, unilateral pain, migraine in the family Nausea, unilateral pain, migraine in the family Nausea unilateral pain, migraine in the family, visual aura Total DISCUSSION AND CONCLUSIONS The present study is an epidemiological investigation of the prevalence of migraine and other headaches in schoolchildren aged and resident in two big Finnish cities of similar social and environmental character. The age of the schoolchildren may be considered to be an early puberty, since approximately half of the Finnish girls have their first menstruation at the age of (). The ratio of schoolchildren who had had disturbing headaches during the 12 months (in 190) to those with no headache was two to one, i.e. two thirds of the pupils aged and experienced headaches. This figure is distinctly lower than that obtained from another study made by the same method of 13-yearold schoolchildren (l), but higher than the prevalence figures of younger pupils (6,, ). It is possible that moving from primary to secondary school at the age of 13, temporarily increases the occurrence of headache in those pupils who are liable to get headaches, but who usually do not complain of headache. The prevalence figure of the present study almost equalled that of Bille s (6) for -agers. Migraine was complained of by 10.2% of the total group of pupils. It is also somewhat lower than the figure obtained from the study of 13-year-old-pupils , (1). Bille s study population (6), collected in the middle of the 190 s. showed.3% with migraine. The doubling of the prevalence of migraine investigated on the same criteria more than a quarter of a century ago, may be due to several factors. The present, recently renewed school system is very demanding as to various cognitive skills. The differences between the sexes in the present study are parallel to those found in Bille s (6) investigation. The frequency of single migraine symptoms observed in the present study are similar to those found in previous studies (6, 9 10). ACKNOWLEDGEMENTS The financial aid from AVOHOIDON TUTKIMUS- SAATIO is gratefully acknowledged. REFERENCES 1. Sillanp% M. Prevalence of headache in prepuberty. Headache 192;23: Verbal communication from the municipal school bureau of the cities of Tampere and Turku. 3. Central Statistical Office. Statistical Yearbook of Fin- land 191;:. 4. Vahlquist B. Migraine in children. Int Arch Allergy 19; : Scund I Primary Health Cure 194; 1

6 Scand J Prim Health Care Downloaded from informahealthcare.com by on 0/20/ 32 Kantero R-L, Widholm 0. The age of menarche in Finnish girls in Acta Obstet Gynecol Suppl ; 191; -1. Bille B. Migraine in school children. A study of the incidence and short-term prognosis, and a clinical, psychological and encephalographic comparison between children with migraine and matched controls. Acta Paediatr Scand 1%2; 136:l-11. Egermark-Eriksson I. Prevalence of headache in Swedish schoolchildren. A questionnaire survey. Acta Paediatr Scand 192;1: Sillanpll M. Occurrence of headache amongst schoolchildren in a Northern Finnish community. In: Sicuteri F. ed. Headache: New Vistas. Florence, Biomedical Press, Isler W. Kopkhmerzen im Kindesalter. Ther Umsch 190;2: Prensky A L. Migraine and migraineous variants in pediatric patients. Ped Clin North Am 196;23: Requests for reprints to: Matti Sillanpii, M.Sc.D. Department of Public Health University of Turku Lemminktiisenkatu 1 SF-2020 Turku 2 Finland Scand J Primary Health Care 194;l

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