Headache among adolescents in the general population: Prevalence, impairment and assessment methods
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Headache is one of the most common health problems in adolescents and can negatively affect their quality of life, impair daily function and lead to the development of psychological problems. Adolescence is a period of great strain due to mental and somatic changes associated with development. Therefore, we decided to study the prevalence and burden of headache among adolescents in Norway with a focus on all headaches rather than on only the most bothersome cases commonly addressed by previous epidemiological surveys. In addition, we wanted to develop an internet-based headache diary to see whether it was more useful than a paper diary in terms of adherence. Finally, we explored whether the data in the diary provide information about headaches among adolescents that is not captured by a retrospective interview and/or questionnaire. The thesis was designed both as a cross-sectional study (examining a representative community sample of 488 adolescents aged 12–18 years recruited from mid-Norway) and as a prospective study (three weeks of diary entries). Headache diagnoses were determined using the criteria set down by the International Headache Society (ICHD-3 beta, 2013), and the standardised Pediatric Migraine Disability Assessment (PedMIDAS) was used to evaluate disability due to headache. We found a high one-year prevalence rate of any headache (88%), as well as migraine (36%) and tension-type headache (58%), among adolescents; however, there was a low level of headache-related disability according to the PedMIDAS. With respect to prospective diary entries about headache intensity and frequency, and use of medication, we found that internetbased diaries provided more reliable and credible estimates of headache parameters than paper diaries. Finally, we found that prospective diary recordings during a three-week period provided important information that could supplement results obtained from structured interviews. Therefore, we recommend the use of prospective diary recordings to supplement information obtained at interview when assessing frequent headaches among adolescents and their use of medication, both in the school health service and in clinical practice.