INTRODUCTION: Headache is the most prevalent neurological manifestation in adults and one of the leading causes of disability worldwide. In children and adolescents, headaches are arguably responsible for a remarkable impact on physical and psychological issues, yet high-quality evidence is scarce. MATERIAL AND METHODS: We searched cross-sectional and cohort studies in Embase, Medline, Web of Science, and Cochrane databases from January 1988 to June 2022 to identify the prevalence of headaches in 8-18 years old individuals. The risk of bias was examined with the Joanna Briggs Institute (JBI) scale. A random-effects model was used to estimate the pooled prevalence of pediatric headache. Subgroup analyses based on headache subtypes were also conducted. RESULTS: Out of 5,486 papers retrieved electronically, we identified 48 studies that fulfilled our inclusion criteria. The pooled prevalence of primary headaches was 11% for migraine overall [95%CI: 9-14%], 8% for migraine without aura (MwoA) [95%CI: 5-12%], 3% for migraine with aura (MwA) [95%CI:2-4%] and 17% for tension-type headache (TTH) [95% CI: 12-23%]. The pooled prevalence of overall primary headache in children and adolescents was 62% [95% CI: 53-70%], with prevalence in females and males of 38% [95% CI: 16-66%] and 27% [95% CI: 11-53%] respectively. After the removal of studies ranked as low-quality according to the JBI scale, prevalence rates were not substantially different. Epidemiological data on less common primary headaches, such as trigeminal autonomic cephalalgias, were lacking. CONCLUSION: We found an overall remarkably high prevalence of primary headaches in children and adolescents, even if flawed by a high degree of heterogeneity. Further up-to-date studies are warranted to complete the picture of pediatric headache-related burden to enhance specific public interventions.

Department of Biomedicine Neurosciences and Advanced Diagnostics University of Palermo Palermo Italy

Department of Biotechnological and Applied Clinical Sciences University of L'Aquila L'Aquila Italy

Department of Clinical and Molecular Medicine Sapienza University of Rome Rome Italy

Department of Headache Iranian Center of Neurological Researchers Neuroscience Institute Tehran University of Medical Sciences Tehran Iran

Department of Internal Medicine Division of Vascular Medicine and Pharmacology Erasmus MC University Medical Center Rotterdam the Netherlands

Department of Neurology 3rd Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic

Department of Neurology Wroclaw Medical University Wroclaw Poland

Department of Neuroscience Neurology Unit Bambino Gesù Children's Hospital Istituto Di Ricovero E Cura a Carattere Scientifico Rome Italy

Faculty of Medicine and Pharmacy Vrije Universiteit Brussel Brussels Belgium

Faculty of Physical Therapy and Rehabilitation Hacettepe University Ankara Turkey

Humanitas University Pieve Emanuele Milan Italy

Neurology and Stroke Unit IRCCS Humanitas Research Hospital Rozzano Milan Italy

Wolfson Centre for Age Related Diseases King's College London London UK

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