Abstract
<title>Abstract</title> <p>Background Headache disorders are among the leading neurological causes of years lived with disability globally. (1,2) Population-based epidemiological data on headache in school-age adolescents are scarce across sub-Saharan Africa (3) and virtually absent from the Democratic Republic of Congo (DRC). (4) This study aimed to estimate the 6-month prevalence, clinical phenotype, and sex-related differences in non-febrile acute headache among secondary school students in Bukavu, eastern DRC. Materials and Methods A cross-sectional study was conducted from January to June 2019 in ten secondary schools selected by systematic random sampling from Pool 4 of the Bukavu provincial EPSP sub-division. Using multi-stage proportional sampling, 400 students aged 12–18 years were enrolled. A structured, interviewer-administered questionnaire informed by ICHD-3 criteria (11) collected data on headache characteristics, associated symptoms, precipitating and relieving factors, healthcare utilisation, and academic impact. Binary logistic regression estimated unadjusted odds ratios (OR) with 95% confidence intervals (CI). Results Of 400 students, 270 (67.5%; 95% CI 62.9–72.1%) reported at least one non-febrile headache episode in the preceding six months; females accounted for 57.0% of cases. Possible or probable migraine was the most prevalent headache subtype (47.0%), followed by episodic tension-type headache (36.7%). Female sex was significantly associated with daily headache frequency (OR 2.46; 95% CI 1.36–4.46; p = 0.003), visual disturbances (OR 1.80; 95% CI 1.07–3.02; p = 0.018), and nausea or vomiting (OR 2.15; 95% CI 1.21–3.85; p = 0.005). Headaches were associated with perceived academic underperformance in 63.7% of affected students; 21.5% missed at least one school day per month. Only 7.0% were receiving prophylactic pharmacotherapy. Conclusion Non-febrile headache affects approximately two in three secondary school students in Bukavu and is associated with substantial academic disruption and an unmet need for preventive care. Comparable epidemiological data from the DRC remain scarce; these 2019 pre-pandemic data are discussed as baseline evidence, with the study's temporal limitations addressed below. Headache disorders may represent an overlooked contributor to impaired educational performance in this low-resource setting. School-based screening and primary care training in headache management are warranted.</p>