Temporal trends of migraine and tension‑type headache in adolescents across China, Germany and the US

Introduction: Adolescence (10–19 years) is a critical neurodevelopmental window. This study aimed to describe long‑term temporal trends and disease burden of migraine and tension‑type headache (TTH) and explore sociodemographic inequality among adolescents in China, the US, and Germany from 1990 to 2021. Methods: Incidence, prevalence, and years lived with disability (YLDs) were extracted from the Global Burden of Disease 2021 study stratified by country, age (10–14 and 15–19 years), and sex. Joinpoint regression calculated average annual percent changes (AAPCs) for age-standardised incidence, prevalence, and YLD rates (ASIR, ASPR, ASYR, respectively). Frontier analysis, slope index of inequality, and concentration index assessed socio-demographic index (SDI) associations and inequalities. Results: China had the largest absolute case numbers but lowest age‑standardised rates (migraine AAPC = 0.27%, TTH = 0.31%). Girls carried a substantially higher burden than boys across all 3 countries. The US and Germany showed higher ASRs with generally stable or declining trends. Migraine was more common in 10–14‑year‑olds, while TTH was more frequent in 15–19‑year‑olds. Migraine burden became increasingly concentrated in higher-SDI countries with widening absolute and relative inequalities, whereas TTH-related inequalities slightly attenuated over the study period. Conclusion: China’s rapidly rising SDI and population structure were associated with the increase in headache burden. High‑SDI countries maintained a relatively stable burden, likely due to mature health services. Worsening socioeconomic inequalities were observed for migraine, while TTH showed a mild mitigating trend. Potential targeted strategies include school‑based screening for headache in China, expanded youth telehealth in the US, and stress management programmes in Germany.