Abstract / Summary
Background: Primary headache disorders are among the most common neurological conditions affecting children and adolescents and are associated with recurrent pain, school-related difficulties, and reduced quality of life.Although migraine and tension-type headache (TTH) are the predominant pediatric headache phenotypes, data from hospital-based settings in South India remain limited.This study aimed to determine the distribution of primary headache phenotypes and describe their clinical characteristics, associated symptoms, pain severity, lifestyle-related factors, and reported school-related indicators among children attending a tertiary-care hospital.Methods: A hospital-based cross-sectional analytical study was conducted in the Department of Paediatrics, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India.A total of 220 children aged 6-15 years with primary headache disorders were enrolled using consecutive sampling.Demographic characteristics, headache profile, associated symptoms, screen exposure, precipitating and relieving factors, school-related indicators, nutritional status, and pain severity were assessed using a structured questionnaire and clinical evaluation.Results: Among the 220 participants, the median age was 14 years, and 125 (56.8%) were female.Tensiontype headache was the most common phenotype, occurring in 110 (50.0%) children, followed by migraine in 65 (29.5%),chronic persistent headache in 24 (10.9%), and other primary headache disorders in 21 (9.5%).Most children, 163 (74.1%), experienced headaches on 1-15 days per month, and the mean Visual Analog Scale (VAS) pain score was 5.28 ± 1.97.Moderate and severe pain were reported by 122 (55.5%) and 52 (23.6%) participants, respectively, while 113 (51.4%) children reported medication use for headache relief.Visual disturbances were reported in 49 (22.3%)children, followed by sensitivity to sound and nausea/vomiting as other commonly reported associated symptoms.Reported scholastic difficulties were observed in 119 (54.1%) children, and school absenteeism was frequently reported.Conclusion: Tension-type headache was the predominant primary headache phenotype in this tertiary-care pediatric cohort.Primary headache disorders were associated with considerable clinical burden, including moderate-to-severe pain, medication use, reported scholastic difficulties, and school absenteeism.Screen exposure was a commonly reported lifestyle characteristic requiring consideration during clinical assessment rather than an established determinant of headache severity.Comprehensive management strategies incorporating accurate symptom recognition, lifestyle counseling, sleep optimization, nutritional assessment, stress management, and evaluation of reported school-related indicators may support appropriate headache care among affected children.