Undifferentiated Headache: Austrian Study Highlights Need to Assess This New Diagnostic Category – Neurology Advisor

By | December 27, 2019

Headaches among children and adolescents in Austria are common, with over 75% experiencing some form of headache, and further research is needed to assess the new diagnostic category of undifferentiated headaches, according to a study published in The Journal of Headache and Pain.

The aim of this epidemiological study was to evaluate the prevalence, burden, medication usage, health-related quality of life, and sociodemographic characteristics as they relate to headaches in children and adolescents living in Austria. Researchers included the new diagnostic category of undifferentiated headaches, which is defined as a mild headache lasting <1 hour. Data was collected from students in grades 5, 7, 9, and 11 in schools willing and able to participate across the country of Austria.

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The child and adolescent Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation questionnaire assessed screening, diagnostic, and burden variables. Answers about diagnostic variables were used to categorize headaches into undifferentiated headaches, migraine (definite and probable), tension-type headaches (definite and probable), and headaches occurring ≥15 days/month. The KIDSCREEN questionnaire assessed health-related quality of life. Sociodemographic variables were assessed using a questionnaire about socioeconomic status, migration background, and place of residence.

Of the 3386 students who completed the questionnaires, 55.4% were girls, 53.5% had a medium socioeconomic status, 74.3% lived with both of their biological parents, and 58.5% lived in an urban community. Overall, 75.7% of the students experienced ≥1 headache over the course of the previous year. For girls, 26.5% experienced undifferentiated headaches, 28.1% experienced migraines, 22.4% experienced tension-type headaches, and 4.1% experienced headaches occurring ≥15 days/month. For boys, 25.5% experienced undifferentiated headaches, 19.5% experienced migraines, 20.7% experienced tension-type headaches, and 1.7% experienced headaches occurring ≥15 days/month. Girls experienced more migraines and headaches occurring ≥15 days/month than boys and all headaches increased from grade 5 to grade 11 (P <.001). Undifferentiated headaches decreased with maturity while specific headaches increased with maturity (P <.05).

Logistic regression models indicated that being a girl was associated with migraines (odds ratio [OR], 1.5) and with headaches occurring ≥15 days/month (OR 2.4), increased maturity was associated with migraines and tension-type headaches, and living with a single parent or patchwork families was associated with migraines (OR 1.5).

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Headaches caused 15.6% of students to miss ≥1 day of school, 11.7% of students to leave school early, and 41.9% of students to be unable to complete intended activities.

Acute headache medication was used by 49.6% of students. Health-related quality of life was reduced in students with any headache when compared with students without headache in the categories of self-perception, parent-relations, home life, and school environment (P <.001, for all).

Limitations of this study include potential recall problems and misunderstandings due to the use of questionnaires, the inability to assess causation in the cross-sectional design, and a high nonparticipation proportion among students.

The researchers concluded that headaches “are burdensome in terms of ill health, impaired quality of life, and interference with education” and “[undifferentiated headaches] may be a precursor or immature form of migraine or [tension type headache].”


Philipp J, Zeiler M, Wöber C, et al. Prevalence and burden of headache in children and adolescents in Austria – a nationwide study in a representative sample of pupils aged 10–18 yearsJ Headache Pain. 2019;20(1):101.

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