Prevalence of migraine and association between migraine headache and refractive errors among adolescents in secondary schools in Ibadan, Nigeria

Abstract

Background: Migraine is frequently overlooked and underdiagnosed among school-aged children and adolescents,
despite its potential to cause significant morbidity, negatively affect quality of life, and lead to school absenteeism.
Its sporadic nature and low fatality often result in an underestimated public health burden. While migraine and
headache associated with refractive errors are reported globally among adolescents, data from African settings
remain limited. This study aimed to determine the prevalence of migraine headache and its association with
refractive errors (type and severity) among secondary school students.
Methodology: This cross-sectional, descriptive, multi-school study involved secondary school students selected
via multistage sampling with probability proportional to size. Eligible students underwent visual acuity testing,
ocular examination, and refraction. Migraine was assessed using criteria from the International Classification for
Headache Disorders and an interviewer-administered semi-structured questionnaire.
Results: A total of 775 students from 6 schools participated, including 352 (45.4%) males and 423 (54.6%)
females, with a mean age of 14.5 ± 1.85 years. The prevalence of migraine headache was 18.3%, with gender
specific rates of 10.2% in males and 25.1% in females. There was a significant association between migraine and
both the type and severity of refractive error. Students with mild refractive error had 3.42 times higher odds of
migraine (95% CI, 1.74–6.75) than those with moderate error. Astigmatism was associated with 1.53 times,
increased odds, of migraine (95% CI, 0.98–2.40) compared to myopia.
Conclusion: Migraine is common and underdiagnosed among secondary school students and is significantly
associated with refractive errors. Periodic school eye screenings that assess both refractive errors and migraine
headaches, with appropriate referral pathways, are recommended.