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<p>Primary headaches represent a major public health burden in the pediatric population, with a prevalence exceeding 60%. They significantly impair quality of life, school attendance, and family dynamics, often manifesting as a complex biopsychosocial condition. This review provides a comprehensive update on the epidemiology, clinical classification, and comorbidities of pediatric primary headaches, offering a critical analysis of current diagnostic pathways and evolving therapeutic strategies. We examined recent literature, ICHD-3 classification criteria, and international consensus guidelines (AAN/AHS), focusing on the pathophysiology, neuro-psychiatric associations, and evidence-based management of migraine and tension-type headache in developmental age. Clinical evidence highlights a significant bidirectional comorbidity between headaches and neurodevelopmental disorders (ADHD, learning disabilities) as well as mood disorders (anxiety, depression), likely mediated by shared neurotransmitter dysregulation. Diagnosis remains fundamentally clinical, relying on history taking and “red flag” exclusion to rule out secondary etiologies. Regarding management, the therapeutic paradigm has shifted towards a “bio-behavioral first” approach, following evidence of high placebo response rates in prophylaxis trials (CHAMP study). While NSAIDs and triptans remain the cornerstone of acute care, emerging anti-CGRP therapies represent a promising frontier for refractory cases. Effective management of pediatric headache requires a multidisciplinary approach. The integration of lifestyle modifications, behavioral interventions (CBT, biofeedback), and judicious pharmacotherapy is superior to single-modality treatments in reducing disability, improving global functioning, and preventing chronification.</p>

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Multidisciplinary management of headache in developmental age: effects on school performance, quality of life, and therapeutic perspectives

  • 期刊论文

  • 发表日期：

    2026年5月29日

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  • Francesco Ferrara,
  • Flavia De Berardinis

摘要

Primary headaches represent a major public health burden in the pediatric population, with a prevalence exceeding 60%. They significantly impair quality of life, school attendance, and family dynamics, often manifesting as a complex biopsychosocial condition. This review provides a comprehensive update on the epidemiology, clinical classification, and comorbidities of pediatric primary headaches, offering a critical analysis of current diagnostic pathways and evolving therapeutic strategies. We examined recent literature, ICHD-3 classification criteria, and international consensus guidelines (AAN/AHS), focusing on the pathophysiology, neuro-psychiatric associations, and evidence-based management of migraine and tension-type headache in developmental age. Clinical evidence highlights a significant bidirectional comorbidity between headaches and neurodevelopmental disorders (ADHD, learning disabilities) as well as mood disorders (anxiety, depression), likely mediated by shared neurotransmitter dysregulation. Diagnosis remains fundamentally clinical, relying on history taking and “red flag” exclusion to rule out secondary etiologies. Regarding management, the therapeutic paradigm has shifted towards a “bio-behavioral first” approach, following evidence of high placebo response rates in prophylaxis trials (CHAMP study). While NSAIDs and triptans remain the cornerstone of acute care, emerging anti-CGRP therapies represent a promising frontier for refractory cases. Effective management of pediatric headache requires a multidisciplinary approach. The integration of lifestyle modifications, behavioral interventions (CBT, biofeedback), and judicious pharmacotherapy is superior to single-modality treatments in reducing disability, improving global functioning, and preventing chronification.