A Large-Scale Epidemiological Survey of Migraine Among School-Age Children and Adolescents in Southern Zhejiang and Northern Fujian, China: Prevalence, Clinical Profiles, and Risk Factors

<title>Abstract</title> <p>Objective To determine the prevalence, demographic distribution, attack characteristics, disease burden, and associated factors of migraine among school-aged children and adolescents in China. Methods This cross-sectional survey employed a stratified multistage random cluster sampling design across 26 schools in southern Zhejiang and northern Fujian. A validated structured questionnaire was administered on-site; suspected cases were independently diagnosed by two senior headache neurologists using ICHD-3 criteria and the Diagnostic Criteria for Vestibular Migraine of Childhood (VMC). Of 8,000 distributed questionnaires, 7,384 were valid (92.30% response rate; mean age 14.65 years). Chi-square tests, binary logistic regression, and multivariate logistic regression were used for analyses. Results The overall migraine prevalence was 7.04% (520/7,384). Vestibular migraine accounted for 1.63%, migraine with aura 1.19%, and migraine without aura 4.22%. Prevalence was significantly higher in females than males (9.06% vs. 5.15%, P &lt; 0.001), increased progressively with grade level (peaking in senior high school grade 2 at 10.61%), and was associated with height 155–170 cm (8.25%) and myopia duration &gt; 10 years (11.35%). Among migraineurs, most had 4–15 attack days/month (67.12%), 2–24 h duration (92.50%), and moderate pain (VAS 4–6, 76.92%). Over the preceding 3 months, mean academic impact was 4.38 days, headache-related leave was 1.42 days, missed social/leisure activities was 1.62 days, and family escort was 1.31 days—all showing a senior high &gt; junior high &gt; primary school gradient. Only 42.88% had ever sought medical care, and 37.31% were misunderstood by parents as "school-avoidant" or "feigning illness." Conclusion Migraine is prevalent among Chinese school-aged youth, with significant demographic disparities and substantial, grade-dependent disease burden. Low medical consultation and high parental misunderstanding highlight urgent needs for integrated school-family-medical intervention programs.</p>