Temporal trends, social inequalities, and COVID-19 impacts of migraine and tension-type headache in adolescents across China, Germany, and the USA from 1990 to 2021

Background Adolescence (10–19 years) is a critical neurodevelopmental window. This study analyzed temporal trends, disease burden, SDI-related inequalities, and COVID-19 impacts on migraine and tension-type headache (TTH) among 10-19-year-olds in China, USA, and Germany (1990–2021). Methods GBD 2021 data extracted for incidence, prevalence, YLDs by country, age (10–14, 15–19 years), sex. Joinpoint regression for AAPCs of age-standardized rates (ASIR/ASPR/ASYR). Frontier analysis, SII, CI assessed SDI associations/inequalities. Results Trends diverged: China had the highest absolute cases but lowest ASRs (migraine AAPC = 0.27, TTH = 0.31); the USA/Germany had higher ASRs but stable declining trends. 10-14-year-olds had more migraine, 15-19-year-olds more TTH. COVID-19 worsened China’s burden growth, while the USA and Germany stayed stable. Conclusion China’s rapid SDI and academic pressure drove fastest burden growth; high-SDI nations benefited from mature interventions. COVID-19 amplified inequalities. Priorities: China: school headache screening; USA: expand telehealth for uninsured youth; Germany: scale stress management programs.