Introduction

Headaches are very frequent in adolescence, especially migraine headache (MH) and tension type headache (TTH), whose prevalence is respectively, 8–10 and 15–20 % [1–6]. They can be seriously disabling, interfering with various aspects of everyday life, not just in the family but particularly at school and in inter-person relations [7]. MH is more likely to be associated with stressful experiences such as excessive school demands, school overload, social isolation, perceived teacher unfairness or, later, job dissatisfaction [8, 9]. Even so, relatives and teachers often fail to understand headache and underrate it, and delay sending the sufferer to consult a doctor for appropriate treatment, preferring self-medication.

The aim of this study was to assess the impact of headache among high school students and examine the main types of headaches that interfere with school and daytime social activities.

Materials and methods

Students in the two senior classes at the Communication Private High School “Maestre Pie” in Rimini (Italy) were invited to take part in a study to assess their experience of headaches during the previous 12 months, especially during school time. A self-administered questionnaire interview was done during school hours, consisting of ten items which reported basic personal details and family history; diagnosis of headache based on three typical headache features (according to the 2004 IHS diagnostic criteria), one for MH, one for TTH and one for unclassifiable headache; at what time of day the headache started, triggering factors; disability measured using the migraine disability assessment (MIDAS); and treatment. Descriptive statistical analysis was done.

Results

A total of 60 students aged 17–20 years, 79 % females, were analyzed; 84 % (51) reported recurrent headache during the last 12 months; 25 % had headache during morning lessons, 20 % in the afternoon and only 3 % in the evening; 52 % did not specify. A family history was reported by 74 % of the sufferers, in the maternal line. Nearly half, 53 % (27 subjects), were identified as having MH and 31 % (16) TTH; the remaining 16 % (8) had unclassifiable headaches. In 37 % of the MH sufferers the headache lasted from 6 to 72 h; it was strong in 36 %; pulsating in 43 %, and got worse with movement (gym, jogging, going up stairs) in 57 %. A quarter (25 %) felt nauseous during the attack and 7 % vomited. Just over half (52 %) reported photophobia and 72 % phonophobia; 43 % did not eat during their break or at lunch.

Among those who reported TTH, 30 % had pain throughout the head; 30 % said it was mild and 44 % moderate.

Table 1 lists the main causes of the headaches. The most frequent triggers were tiredness, stress in general or in relation to some task or tests during a lesson, and too little sleep.

Table 1 Triggers or factors aggravating headache
Full size table

The MIDAS questionnaire was completed by 45 headache students. Of these, 62 % (28) rated their disability as grade I, minimal or infrequent (mean score 1.64); 17 % (8) rated it as grade II, mild or infrequent (mean score 8.37); 11 % (5) opted for grade III, moderate (mean score 14.2) and 9 % (4) for grade IV, severe (mean score 51.25). Most of the headache sufferers (92 %) had trouble following lessons, doing afternoon sport, and completing their homework.

To relieve their headaches, 56 % took over-the-counter analgesics. None of the students who complained of strong, seriously debilitating headache (9) had ever taken anything to prevent it.

In response to the question of what ideas they had about the headache, 92 % gave no reply; 90 % had never read anything about headache or watched or listened to a program on TV or radio.

Discussion

To date, there are only few studies of headache at school, and our findings that 84 % of children suffer headaches at school are in line with other reports [8, 10–12]. We found more MH patients than in other studies but, although the percentage was lower, it was always higher than TTH [2, 10].

In the present study headache peaked during morning lessons or in the afternoon. This might be related to “school stressors”, as mentioned in earlier studies of the impact of headache during schooltime, and the relationships between recurrent headaches and various psychological stressors [8, 11, 13, 14]. We too found that tiredness and stress were the most frequently reported triggers, followed by lack of sleep—probably all related; 92 % of headache sufferers said they had trouble following lessons because of these problems. Among the MH sufferers, 20 % had medium–high MIDAS scores, similarly to previous case series [15].

Nearly 90 % had never tried to obtain information on their headaches, and more than half used OTC products for pain relief. None had ever consulted a specialist or a headache center to find about prevention or the most appropriate therapeutic strategies.

Educational program must be drawn to raise awareness on the suffering students about their condition and the possibility to face these diseases correctly. It is well demonstrated that such awareness can reduce the intake of drugs and can minimize the risk of developing a medication-overuse headache [16]. Moreover, taking the specific drugs can improve the course of migraine and can restore the normal functional condition [17].

Conclusions

This study highlights the need to promote headache education programs, starting at high school, to improve communication between teachers, family, physicians, and adolescent patients, with the goal of early, appropriate therapeutic intervention in order to avoid the need for self-medication, to improve the quality of life, and to prevent long-term or progressive headaches in adult life.