背景:我们最近发现头痛疾病在伊朗儿童(6-11岁)和青少年(12-17岁)中非常普遍(性别和年龄调整后的1年患病率:偏头痛25.2%,紧张型头痛12.7%,未分化头痛[UdH]22.1%,可能的药物过度使用头痛[pMOH]1.1%,其他头痛≥15天/月[H15+]3.0%)。在这里,我们报告头痛的负担,从同一研究中获取证据。
方法:在横断面调查中,遵循由全球头痛运动领导的全球学校研究的通用协议,我们管理了儿童和青少年版本的头痛原因限制,残疾,121所学校的社会障碍和受损者参与(HARDSHIP)结构化问卷,有目的地选择以反映国家的多样性。学生在课堂上自己完成这些,在监督下。头痛诊断问题基于ICHD-3标准,但包括UdH(定义为轻度头痛,通常持续时间<1小时)。负担调查涉及多个领域。
结果:分析的样本(N=3,244)包括1,308(40.3%)儿童和1,936(59.7%)青少年(1,531[47.2%]男性,1,713[52.8%]女性)。非参与比例为3.4%。平均头痛频率为3.9天/4周,和平均持续时间1.8h。在发作状态下估计的平均时间比例为1.1%(偏头痛为1.4%,pMOH为16.5%)。症状药物平均消耗1.6天/4周。损失的上学时间平均为0.4天/4周(2%,假设一周5天),但pMOH高出11倍(4.3天;22%)。对于大多数头痛类型,据报道,活动有限的天数比学校损失的天数高出几倍(pMOH为45%,25%为其他H15+)。几乎每12个父母中就有一个(7.9%)因儿子或女儿的头痛而在4周内至少错过一次工作。情绪影响和生活质量得分反映了这些负担指标。
结论:头痛,在伊朗的儿童和青少年中很常见,与症状负担有关,对某些人来说可能是繁重的,但对大多数人来说不是。然而,有大量的相应负担,特别是对于pMOH的1.1%和其他H15+的3.0%,他们遭受教育障碍和潜在的重大生活障碍。这些发现对伊朗的教育和卫生政策具有重要意义。
BACKGROUND: We recently found headache disorders to be highly prevalent among children (aged 6-11 years) and adolescents (aged 12-17) in Iran (gender- and age-adjusted 1-year prevalences: migraine 25.2%, tension-type headache 12.7%, undifferentiated headache [UdH] 22.1%, probable medication-overuse headache [pMOH] 1.1%, other headache on ≥ 15 days/month [H15+] 3.0%). Here we report on the headache-attributed burden, taking evidence from the same study.
METHODS: In a cross-sectional survey, following the generic protocol for the global schools-based study led by the Global Campaign against Headache, we administered the child and adolescent versions of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) structured questionnaire in 121 schools, purposively selected to reflect the country\'s diversities. Pupils self-completed these in class, under supervision. Headache diagnostic questions were based on ICHD-3 criteria but for the inclusion of UdH (defined as mild headache with usual duration < 1 h). Burden enquiry was across multiple domains.
RESULTS: The analysed sample (N = 3,244) included 1,308 (40.3%) children and 1,936 (59.7%) adolescents (1,531 [47.2%] male, 1,713 [52.8%] female). The non-participating proportion was 3.4%. Mean headache frequency was 3.9 days/4 weeks, and mean duration 1.8 h. Estimated mean proportion of time in ictal state was 1.1% (1.4% for migraine, 16.5% for pMOH). Symptomatic medication was consumed on a mean of 1.6 days/4 weeks. Lost school time averaged 0.4 days/4 weeks overall (2%, assuming a 5-day week), but was eleven-fold higher (4.3 days; 22%) for pMOH. For most headache types, days of reported limited activity were several-fold more than days lost from school (45% for pMOH, 25% for other H15+). Almost one in 12 parents (7.9%) missed work at least once in 4 weeks because of their son\'s or daughter\'s headache. Emotional impact and quality-of-life scores reflected these measures of burden.
CONCLUSIONS: Headache, common in children and adolescents in Iran, is associated with symptom burdens that may be onerous for some but not for most. However, there are substantial consequential burdens, particularly for the 1.1% with pMOH and the 3.0% with other H15+, who suffer educational disturbances and potentially major life impairments. These findings are of importance to educational and health policies in Iran.