The role of stress in the development of headaches in children: A narrative review

Headaches are among the most common neurological disorders in the pediatric population and represent a significant health problem affecting the quality of life, social functioning, and academic performance of children and adolescents. Increasing attention has been directed toward the role of psychosocial factors, particularly stress, in the development and exacerbation of headache disorders. The aim of this study was to review current literature regarding the role of stress in the development and exacerbation of headaches in children and adolescents. A literature review was conducted using publications available in the PubMed and PubMed Central (PMC) databases. Studies concerning pediatric populations published between 2020 and 2025 were included. Review articles, observational studies, and clinical studies investigating the relationship between stress and headache occurrence in children and adolescents were analyzed. The reviewed literature demonstrated a significant association between stress and both migraine and tension-type headaches. The most frequently identified stressors included academic demands, family-related problems, interpersonal difficulties, and chronic emotional tension. The studies also highlighted the importance of sleep disturbances, anxiety and depressive symptoms, and maladaptive coping strategies. Potential biological mechanisms linking stress and headaches include dysregulation of the hypothalamic–pituitary–adrenal axis and activation of the autonomic nervous system. Stress is an important factor influencing the occurrence and course of headaches in children and adolescents. Early identification of stress-related factors and the implementation of preventive and therapeutic interventions, including both pharmacological treatment and psychological support, may contribute to reducing headache frequency and severity while improving the quality of life of pediatric patients.