Objectives-To determine the prevalence rates of the various causes of severe headache in school-children, with special emphasis on migraine and its impact on school attendance. Design-Population based study in two stages, comprising an initial screening questionnaire followed by clinical interviews and examination of children with symptoms and a control group of asymptomatic children matched for age and sex. Setting-67 primary and secondary schools in the city of Aberdeen. Subjects-2165 children, representing a random sample of 10% of schoolchildren in Aberdeen aged 5-15 years. Main outcome measures-(a) the prevalence of migraine (International Headache Society criteria) and of other types of headache; (b) the impact of migraine on school attendance. Results-The estimated prevalence rates of migraine and tension headache were 10.6% (95% confidence interval 9.1 to 12.3) and 0.9% (0.5 to 1.5) respectively. The estimated prevalence rates for migraine without aura and migraine with aura were 7.8% (95% confidence interval 6.5 to 9.3) and 2.8% (2.0 to 3.8) respectively. In addition, 10 children (0.7%) had headaches which, though lasting less than two hours, also fulfilled the International Headache Society criteria for migraine, 14 (0.9%) had tension headaches, and 20 (1.3%) had non-specific recurrent headache. The prevalence of migraine increased with age, with male preponderance in children under 12 and female preponderance thereafter. Children with migraine lost a mean of 7.8 school days a year due to all illnesses (2.8 days (range 0-80) due to headache) as compared with a mean of 3.7 days lost by controls. Conclusions-Migraine is a common cause of headache in children and causes significantly reduced school attendance.
