The global burden of migraine and tension-type headache, 1990-2021: a multi-model Bayesian meta-regression with decomposition of age-period-cohort effects, health inequalities, and frontier analysis.

BACKGROUND: The Global Burden of Disease Study 2021 (GBD 2021) indicates that headache disorders constitute a major global public health burden. Based on its data, this study constructed models of migraine and tension-type headache across 204 countries and 21 regions to systematically analyze their epidemiological characteristics. METHODS: The analysis stratified prevalence by age, sex, and Socio-demographic Index (SDI), and applied decomposition methods to quantify the attributable burden. Age-Period-Cohort models and spatiotemporal models of health inequality were constructed to assess burden disparities. BAPC models were employed to project trends over the next decade, with 95% uncertainty intervals generated through Monte Carlo simulation. RESULTS: In 2021, the global prevalence of the two types of headache remained largely unchanged compared to 1990, but years lived with disability (YLDs) increased significantly, with the heaviest burden observed among young and middle-aged women. Migraine was most prevalent in Tropical Latin America and Western Europe, while tension-type headache was highest in High-income North America; the fastest increases were observed in the Andean Latin America and East Asia regions. Notable increases occurred in Singapore and China, whereas Thailand showed a significant decline. The burden was strongly positively correlated with the SDI, and the suppressive effect of aging on migraine showed gender-specific differences. CONCLUSION: This study is the first to integrate age-period-cohort analysis, health inequality decomposition, frontier analysis, and multi-model prediction to quantify the drivers of migraine and TTH burden up to 2021, addressing key evidence gaps left by prior GBD studies.