Rising global burden of migraine among adolescents and young adults: a 30-year analysis (1990–2021)

Background: Migraine significantly impacts the physical and mental health of adolescents and young adults (AYA, aged 10-24 years). This study aims to assess global trends in migraine incidence, prevalence, and DALYs in this age group from 1990 to 2021, providing evidence to guide prevention and policy efforts. Materials and methods: Data were obtained from the Global Burden of Disease (GBD) 2021 study, encompassing AYA's migraine burden across 204 countries and territories over the past 30 years, stratified by sex, age, socio-demographic index (SDI), location and year. The assessment analyzed incidence, prevalence, and disability-adjusted life years (DALYs). Results: Between 1990 and 2021, the global burden of migraine among AYA increased markedly in terms of absolute case numbers. Incident cases rose by 23.50%, prevalent cases by 24.82%, and DALYs by 24.94%. Despite these increases, the overall rates and age-standardized rates (ASRs) remained relatively stable, suggesting that population growth and aging are key drivers. The burden was consistently higher in females and in high-SDI regions; however, the rate of increase was greater in males, gradually narrowing the sex gap. Age-wise, those aged 10-14 had the highest incidence rate (45.9%), while the 20-24 group bore the greatest prevalence (39.8%) and DALY burden (39.9%). Among 21 regions, Western Europe recorded the highest ASIR (2272.50 per 100,000), while Tropical Latin America had the highest ASPR (27542.29 per 100,000) and ASDR (1011.78 per 100,000). Nationally, Belgium had the highest ASIR (2758.02 per 100,000), and Brazil had the highest ASPR (27592.69 per 100,000) and ASDR (1013.43 per 100,000). However, projections indicated that ASIR, ASPR, and ASDR will continue to rise by 2035. Conclusion: Global migraine burden surged (1990-2021), with high-SDI regions facing highest DALYs and low-SDI areas underdiagnosed. AYA (10-14, especially females) show peak incidence due to hormonal/social factors. Despite projected ASR decline, cases will rise, demanding precision interventions: healthcare access, sex-specific strategies, and school-based programs. Urgent global efforts are required to promote equitable access to migraine care and prevention, as well as to advance research on emerging risk factors, such as air pollution, prolonged screen exposure, chronic stress, academic pressure, and others.