Analysis of disease burden and trends of tension-type headache in China and globally from 1990 to 2021_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Pan ¹ , XIE Xiaohua ² , LIN Derong ² , LI Zhongxian ¹ , ZHOU Xiayun ¹ , LIANG Junquan ¹ , JIAO Zitong ¹ , JI Qiaoyu ¹ , LI Jingjing ¹ , YAN Luda ¹ ,  ZHOU Peng ¹

1. Department of Acupuncture, The Seventh Clinical College of Guangzhou University of Chinese Medicine, Shenzhen Bao’an Traditional Chinese Medicine Hospital, Shenzhen 518133, P. R. China;
2. Department of Acupuncture, Dongguan Hospital of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Dongguan 523000, P. R. China;

Corresponding?author：

ZHOU Peng, Email: Zhoupeng80@gzucm.edu.cn

Keywords：

Tension-type headache; Burden of disease; SDI analysis; Frontier analysis; Decomposition analysis

DOI：

10.7507/1672-2531.202506156

Video：

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Objetive To analyze the burden of disease and changing trends of tension-type headache (TTH) in China and globally from 1990 to 2021. Methods Based on the latest global burden of disease (GBD) 2021 data, the incidence, prevalence, disability-adjusted life years (DALYs), and age-standardised incidence rate (ASIR), age-standardised prevalence rate (ASPR) and age-standardised disability-adjusted life year rate (ASDR) of TTH as the indicators for disease burden assessment. And trends were analyzed by average annual percent change (AAPC). In-depth analysis was carried out by combining socio-demographic index (SDI), frontier analysis, and decomposition analysis methods. Results During the period from 1990 to 2021, the ASIR of TTH in China increased from 6 467.407 per 100 000 to 6 851.134 per 100 000 (AAPC=12.028%), the ASPR rose from17 174.483 per 100 000 to 18 525.067 per 100 000 (AAPC=42.680%), and the ASDR increased from 41.791 per 100 000 to 43.498 per 100 000 (AAPC=0.052%). In contrast, the global ASIR of TTH declined from 8 960.345 per 100 000 to 8 931.311 per 100 000 (AAPC=?1.004%), the ASPR decreased from 24 904.846 per 100 000 to 24 764.722 per 100 000 (AAPC=?4.905%), and the ASDR dropped from 56.989 per 100 000 to 55.694 per 100 000 (AAPC=?0.042%). Gender differences revealed that all disease burden indicators were consistently higher in females than those in males. However, in China, the rates of increase in these indicators were more significant among males. The crude incidence and prevalence rates exhibited a bimodal age distribution. Conclusion The disease burden of TTH in China has demonstrated a significant upward trend, with notable disparities by gender and age.

Citation： ZHANG Pan, XIE Xiaohua, LIN Derong, LI Zhongxian, ZHOU Xiayun, LIANG Junquan, JIAO Zitong, JI Qiaoyu, LI Jingjing, YAN Luda, ZHOU Peng. Analysis of disease burden and trends of tension-type headache in China and globally from 1990 to 2021. Chinese Journal of Evidence-Based Medicine, 2026, 26(3): 277-284. doi: 10.7507/1672-2531.202506156 Copy

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2.	GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the global burden of disease study 2016. Lancet, 2017, 390(10100): 1211-1259.
3.	Waliszewska-Prosó? M, Montisano DA, Antolak M, et al. The impact of primary headaches on disability outcomes: a literature review and meta-analysis to inform future iterations of the global burden of disease study. J Headache Pain, 2024, 25(1): 27.
4.	Yao C, Wang Y, Wang L, et al. Burden of headache disorders in China, 1990-2017: findings from the global burden of disease study 2017. J Headache Pain, 2019, 20(1): 102.
5.	Zhang Y, Li C, Chen N, et al. Prevalence of migraine and other types of primary headache in China: a systematic review and meta-analysis. Neuroepidemiology, 2025, 25: 1-11.
6.	Liu H, Dong M, Liu K, et al. Status of diagnosis and preventative treatment for primary headache disorders: real-world data of unmet needs in China. J Headache Pain, 2023, 24(1): 119.
7.	Yu S, Liu R, Zhao G, et al. The prevalence and burden of primary headaches in China: a population-based door-to-door survey. Headache, 2012, 52(4): 582-591.
8.	姚凌子, 蔣德楠, 吳靜, 等. 1990-2021年全球兒童青少年緊張性頭痛患病率時間變化趨勢研究. 中國當代兒科雜志, 2024, 26(10): 1058-1065.
9.	Olesen J. International classification of headache disorders. Lancet Neurol, 2018, 17(5): 396-397.
10.	GBD 2021 Gout Collaborators. Global, regional, and national burden of gout, 1990-2020, and projections to 2050: a systematic analysis of the global burden of disease study 2021. Lancet Rheumatol, 2024, 6(8): e507-e517.
11.	GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the global burden of disease study 2021. Lancet, 2024, 403(10440): 2133-2161.
12.	Su M, Wang T, Zou C, et al. Global, regional, and national burdens of Alzheimer's disease and other forms of dementia in the elderly population from 1999 to 2019: a trend analysis based on the global burden of disease study 2019. Ibrain, 2024, 10(4): 488-499.
13.	Liu Y, Wang Z, Rader B, et al. Associations between changes in population mobility in response to the COVID-19 pandemic and socioeconomic factors at the city level in China and country level worldwide: a retrospective, observational study. Lancet Digit Health, 2021, 3(6): e349-e359.
14.	Zhu S, Gao J, Zhang L, et al. Global, regional, and national cardiovascular disease burden attributable to smoking from 1990 to 2021: findings from the GBD 2021 study. Tob Induc Dis, 2025: 23.
15.	Bai Z, Han J, An J, et al. The global, regional, and national patterns of change in the burden of congenital birth defects, 1990-2021: an analysis of the global burden of disease study 2021 and forecast to 2040. EClinicalMedicine, 2024, 77: 102873.
16.	Chevan A, Sutherland M. Revisiting das gupta: refinement and extension of standardization and decomposition. Demography, 2009, 46(3): 429-449.
17.	Xu R, Zhang R, Dong L, et al. An analysis of the burden of migraine and tension-type headache across the global, China, the United States, India and Japan. Front Pain Res (Lausanne), 2025, 6: 1539344.
18.	Luo N, Qi W, Tong W, et al. Prevalence and burden of headache disorders in two neighboring provinces of China. J Clin Neurosci, 2014, 21(10): 1750-1754.
19.	Crystal SC, Robbins MS. Epidemiology of tension-type headache. Curr Pain Headache Rep, 2010, 14(6): 449-454.
20.	Fuensalida-Novo S, Jiménez-Antona C, Benito-González E, et al. Current perspectives on sex differences in tension-type headache. Expert Rev Neurother, 2020, 20(7): 659-666.
21.	Wu J, Yang P, Wu X, et al. Association between secondhand smoke exposure and severe headaches or migraine in never-smoking adults. Headache, 2023, 63(10): 1341-1350.
22.	Lo TW, Chan GH, Lee GKW, et al. Young people's perceptions of the challenges and opportunities during the Mainland China-Hong Kong convergence. Humanit Soc Sci Commun, 2023, 10(1): 302.
23.	Wang HM, Ma AL, Guo TT. Gender concept, work pressure, and work-family conflict. Am J Mens Health, 2020, 14(5): 1557988320957522.
24.	Wang J, Su H, Xie W, et al. Mobile phone use and the risk of headache: a systematic review and meta-analysis of cross-sectional studies. Sci Rep, 2017, 7(1): 12595.
25.	Li C, Zhang L, Zhou J, et al. Prevalence of primary headache disorders among information technology staff in China: the negative effects of computer use and other correlative factors. BMC Public Health, 2020, 20(1): 443.
26.	Zhang L, Yin J, Li J, et al. Association between dietary caffeine intake and severe headache or migraine in US adults. Sci Rep, 2023, 13(1): 10220.
27.	Zhang Y, Shi Z, Hock D, et al. Prevalence of primary headache disorders in a population aged 60 years and older in a rural area of Northern China. J Headache Pain, 2016, 17(1): 83.
28.	Zhang J, Mao Y, Li Y, et al. Association between migraine or severe headache and hypertension among US adults: a cross-sectional study. Nutr Metab Cardiovasc Dis, 2023, 33(2): 350-358.
29.	Cho SJ, Song TJ, Chu MK. Sleep and tension-type headache. Curr Neurol Neurosci Rep, 2019, 19(7): 44.
30.	王振杰, 趙蔓, 陳婷蔚, 等. 中國老年人睡眠障礙患病率的Meta分析. 中國全科醫學, 2022, 25(16): 2036-2043.
31.	Chen Y, Ji H, Shen Y, et al. Chronic disease and multimorbidity in the Chinese older adults' population and their impact on daily living ability: a cross-sectional study of the Chinese longitudinal healthy longevity survey (CLHLS). Arch Public Health, 2024, 82(1): 17.
32.	徐若愚, 王家琛, 林玥彤, 等. 1990-2019年中國偏頭痛發病趨勢及其年齡-時期-隊列分析. 中國循證醫學雜志, 2024, 24(6): 658-665.
33.	Oliveira A, Bensenor I, Goulart A, et al. Socioeconomic and geographic inequalities in headache disability in Brazil: the 2019 national health survey. Headache, 2023, 63(1): 114-126.
34.	Yu S, Zhang M, Zhou J, et al. Headache care in China. Headache, 2014, 54(4): 601-609.
35.	Yu S, Steiner TJ. Lifting the burden of headache in China: managing migraine in a SMART way. J Headache Pain, 2017, 18(1): 79.
36.	Wang H, Chen H. Aging in China: challenges and opportunities. China CDC Wkly, 2022, 4(27): 601-602.

1. Debashish C. Tension type headache. Ann Indian Acad Neurol, 2012, 15(5): 83.
2. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the global burden of disease study 2016. Lancet, 2017, 390(10100): 1211-1259.
3. Waliszewska-Prosó? M, Montisano DA, Antolak M, et al. The impact of primary headaches on disability outcomes: a literature review and meta-analysis to inform future iterations of the global burden of disease study. J Headache Pain, 2024, 25(1): 27.
4. Yao C, Wang Y, Wang L, et al. Burden of headache disorders in China, 1990-2017: findings from the global burden of disease study 2017. J Headache Pain, 2019, 20(1): 102.
5. Zhang Y, Li C, Chen N, et al. Prevalence of migraine and other types of primary headache in China: a systematic review and meta-analysis. Neuroepidemiology, 2025, 25: 1-11.
6. Liu H, Dong M, Liu K, et al. Status of diagnosis and preventative treatment for primary headache disorders: real-world data of unmet needs in China. J Headache Pain, 2023, 24(1): 119.
7. Yu S, Liu R, Zhao G, et al. The prevalence and burden of primary headaches in China: a population-based door-to-door survey. Headache, 2012, 52(4): 582-591.
8. 姚凌子, 蔣德楠, 吳靜, 等. 1990-2021年全球兒童青少年緊張性頭痛患病率時間變化趨勢研究. 中國當代兒科雜志, 2024, 26(10): 1058-1065.
9. Olesen J. International classification of headache disorders. Lancet Neurol, 2018, 17(5): 396-397.
10. GBD 2021 Gout Collaborators. Global, regional, and national burden of gout, 1990-2020, and projections to 2050: a systematic analysis of the global burden of disease study 2021. Lancet Rheumatol, 2024, 6(8): e507-e517.
11. GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the global burden of disease study 2021. Lancet, 2024, 403(10440): 2133-2161.
12. Su M, Wang T, Zou C, et al. Global, regional, and national burdens of Alzheimer's disease and other forms of dementia in the elderly population from 1999 to 2019: a trend analysis based on the global burden of disease study 2019. Ibrain, 2024, 10(4): 488-499.
13. Liu Y, Wang Z, Rader B, et al. Associations between changes in population mobility in response to the COVID-19 pandemic and socioeconomic factors at the city level in China and country level worldwide: a retrospective, observational study. Lancet Digit Health, 2021, 3(6): e349-e359.
14. Zhu S, Gao J, Zhang L, et al. Global, regional, and national cardiovascular disease burden attributable to smoking from 1990 to 2021: findings from the GBD 2021 study. Tob Induc Dis, 2025: 23.
15. Bai Z, Han J, An J, et al. The global, regional, and national patterns of change in the burden of congenital birth defects, 1990-2021: an analysis of the global burden of disease study 2021 and forecast to 2040. EClinicalMedicine, 2024, 77: 102873.
16. Chevan A, Sutherland M. Revisiting das gupta: refinement and extension of standardization and decomposition. Demography, 2009, 46(3): 429-449.
17. Xu R, Zhang R, Dong L, et al. An analysis of the burden of migraine and tension-type headache across the global, China, the United States, India and Japan. Front Pain Res (Lausanne), 2025, 6: 1539344.
18. Luo N, Qi W, Tong W, et al. Prevalence and burden of headache disorders in two neighboring provinces of China. J Clin Neurosci, 2014, 21(10): 1750-1754.
19. Crystal SC, Robbins MS. Epidemiology of tension-type headache. Curr Pain Headache Rep, 2010, 14(6): 449-454.
20. Fuensalida-Novo S, Jiménez-Antona C, Benito-González E, et al. Current perspectives on sex differences in tension-type headache. Expert Rev Neurother, 2020, 20(7): 659-666.
21. Wu J, Yang P, Wu X, et al. Association between secondhand smoke exposure and severe headaches or migraine in never-smoking adults. Headache, 2023, 63(10): 1341-1350.
22. Lo TW, Chan GH, Lee GKW, et al. Young people's perceptions of the challenges and opportunities during the Mainland China-Hong Kong convergence. Humanit Soc Sci Commun, 2023, 10(1): 302.
23. Wang HM, Ma AL, Guo TT. Gender concept, work pressure, and work-family conflict. Am J Mens Health, 2020, 14(5): 1557988320957522.
24. Wang J, Su H, Xie W, et al. Mobile phone use and the risk of headache: a systematic review and meta-analysis of cross-sectional studies. Sci Rep, 2017, 7(1): 12595.
25. Li C, Zhang L, Zhou J, et al. Prevalence of primary headache disorders among information technology staff in China: the negative effects of computer use and other correlative factors. BMC Public Health, 2020, 20(1): 443.
26. Zhang L, Yin J, Li J, et al. Association between dietary caffeine intake and severe headache or migraine in US adults. Sci Rep, 2023, 13(1): 10220.
27. Zhang Y, Shi Z, Hock D, et al. Prevalence of primary headache disorders in a population aged 60 years and older in a rural area of Northern China. J Headache Pain, 2016, 17(1): 83.
28. Zhang J, Mao Y, Li Y, et al. Association between migraine or severe headache and hypertension among US adults: a cross-sectional study. Nutr Metab Cardiovasc Dis, 2023, 33(2): 350-358.
29. Cho SJ, Song TJ, Chu MK. Sleep and tension-type headache. Curr Neurol Neurosci Rep, 2019, 19(7): 44.
30. 王振杰, 趙蔓, 陳婷蔚, 等. 中國老年人睡眠障礙患病率的Meta分析. 中國全科醫學, 2022, 25(16): 2036-2043.
31. Chen Y, Ji H, Shen Y, et al. Chronic disease and multimorbidity in the Chinese older adults' population and their impact on daily living ability: a cross-sectional study of the Chinese longitudinal healthy longevity survey (CLHLS). Arch Public Health, 2024, 82(1): 17.
32. 徐若愚, 王家琛, 林玥彤, 等. 1990-2019年中國偏頭痛發病趨勢及其年齡-時期-隊列分析. 中國循證醫學雜志, 2024, 24(6): 658-665.
33. Oliveira A, Bensenor I, Goulart A, et al. Socioeconomic and geographic inequalities in headache disability in Brazil: the 2019 national health survey. Headache, 2023, 63(1): 114-126.
34. Yu S, Zhang M, Zhou J, et al. Headache care in China. Headache, 2014, 54(4): 601-609.
35. Yu S, Steiner TJ. Lifting the burden of headache in China: managing migraine in a SMART way. J Headache Pain, 2017, 18(1): 79.
36. Wang H, Chen H. Aging in China: challenges and opportunities. China CDC Wkly, 2022, 4(27): 601-602.

Chinese Journal of Evidence-Based Medicine

Analysis of disease burden and trends of tension-type headache in China and globally from 1990 to 2021

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