Headache among children and adolescents in Benin: revised prevalence estimates, and estimates of attributed burden, from a national schools-based study

BACKGROUND: In our earlier report of headache prevalence among children (6-11 years) and adolescents (12-17) in Benin, undifferentiated headache (UdH) was defined conventionally as mild headache lasting < 1 h. In this and similar studies elsewhere in sub-Saharan Africa, we recognised diagnostic uncertainties among the many participants with short-duration headache. Here we make new estimates of prevalence using a modified definition of UdH, and, based on these, estimates of attributed burden. The study was part of the global schools-based programme conducted by the Global Campaign against Headache. METHODS: In a cross-sectional survey, the child and adolescent versions of the structured HARDSHIP questionnaire, translated into West-African French, were completed by pupils in class in 16 schools representative of Benin's urban/rural divide. Headache diagnoses were based on ICHD-3 except for UdH, which we redefined as mild or moderate headache lasting < 1 h. Enquiry included multiple aspects of attributed burden, with a timeframe of 4 weeks and additional enquiry into headache yesterday (HY). RESULTS: Of 2,488 eligible pupils, 193 (or their parents) declined, while 2,295 completed the questionnaires (males 1,156 [50.4%], females 1,139 [49.6%]; children 1,081 [47.1%], adolescents 1,214 [52.9%]; mean age 12.1 ± 3.1 years [median 12]; participating proportion 92.2%). With the modified definition, observed 1-year prevalence of UdH increased from 8.4% to 21.0%, with corresponding reductions for migraine (from 52.1% to 44.9%) and tension-type headache (TTH) (from 21.8% to 17.2%). Mean symptom burden was expressed in moderate headache on 4.2 days/4 weeks, with duration 2.8 h. All headache accounted for 4.0% lost school time according to 4-week recall, 3.3% when assessed from HY (which could not capture lost days immediately preceding weekends or holidays). Almost one in three parents (30.3%) lost time from their own work, those of children more than those of adolescents. Measures of impaired participation clearly distinguished migraine (greater burden) from TTH and UdH CONCLUSIONS: Headache is prevalent among children and adolescents in Benin. The associated lost health and impaired participation, including lost school time with, potentially, lifelong negative impact, are reliably attributed to headache. Attribution to specific headache types is less certain because of unresolved diagnostic difficulties surrounding short-duration headache.