OC-23 | The REPICEF Project: a school-based epidemiological study on primary headaches in children and adolescents

Agnese Onofri,¹ Chiara Rosignoli,¹ Vittorio Trozzi,¹ Martina D’Ambrosio,¹ Benedetta Germani,¹ Roberta Ciuffini,² Raffaele Ornello,¹ Simona Sacco¹ | ¹Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila; ²Department of Clinical Medicine, Public health, Life and Environmental Sciences University of L’Aquila, Italy

Background: Primary headaches are a common and disabling condition in children and adolescents, significantly affecting quality of life, school performance and psychological well-being. Despite this burden, epidemiological data on pediatric headache remain limited, especially in the Italian population. The REPICEF Project was designed to investigate the prevalence and clinical characteristics of primary headaches in a large cohort of school-aged children and adolescents.

Methods: The REPICEF Project (Registr0o EPIdemiologico delle CEFalee) is a school-based epidemiological study conducted in the city of L’Aquila, Italy. A total of 1,037 students aged between 6 and 17 years were recruited from six schools. Data collection was performed using the Italian version of the HARDSHIP questionnaire, a validated tool that assesses headache prevalence, clinical characteristics of headache and associated disability. The study received ethical approval from the Ethics Committee of the Abruzzo Region (Protocol No. 035018 – C.Et.R.A).

Results: Among the children and adolescents, 50.65% reported headaches in the previous three months. The most frequently reported diagnosis was probable migraine (31.48%) of the sample, followed by migraine in 19.17%, TTH in 12.07%, probable TTH in 10.30%, and unclassified daily headache in 14.32%. The prevalence of headache was significantly higher in adolescents aged 12–17 years (46.24%) compared to children aged 6–11 years (26.62%) (p < 0.05). Sex-based differences were also observed: females reported higher rates of migraine (19.55% vs. 18.77%), probable migraine (32.27% vs. 30.62%), probable medication overuse headache (7.50% vs. 1.98%, p < 0.001), and headache on 15 or more days/month (7.50% vs. 2.47%, p = 0.0015), while males had higher rates of TTH (14.32% vs. 10.00%) and unclassified daily headache (17.04% vs. 11.82%, p = 0.038). Regarding symptomatology, 66.27% reported photophobia, 83.55% phonophobia, and 31.01% nausea; in addition, 47.69% reported headache worsening with physical activity and 46.15% reported avoidance of physical activity during headache attacks.

Conclusion: The REPICEF Project confirms a high prevalence of primary headaches also among Italian children and adolescents, with significant differences by age and sex. These primary findings highlight the need for early identification and tailored management strategies in the pediatric population.