OC-24 | A retrospective case-control study aimed at analyzing, through the administration of a questionnaire, the prevalence, clinical features and the risk factors for chronicity in a sample of 419 pediatric patients

Alice Bonuccelli, Sara Mundo, Emma Iacopelli, Alessandro Orsini, Lorenza Marini, Diego Peroni | Neuropediatric, Pediatric Clinic, AOU Pisa, Italy

Background: Headache is one of the most common neurological symptoms in childhood and adolescence, significantly impacting children's physical and mental well-being and their family and school functioning. Both forms (migraine and tension-type headache) can become chronic, often associated with psychiatric comorbidities, medication overuse, sleep disturbances, and other biopsychosocial risk factors.

Methods: A retrospective, cross-sectional, case-control study was conducted to further investigate the epidemiology of headache in children, clinical features and risk factors for chronicity. Data were collected through an anonymous structured questionnaire.

Results: The study included a sample of 419 subjects, aged between 2 and 18 years. The overall prevalence of headache was 22% (26.4% in females and 13.6% in males). The most common subtype was migraine (14.8%), followed by tension-type headache (2.9%) and mixed headache (3.6%). Chronic headaches affected 2.6% of the sample (11 subjects), including 2 cases of medication-overuse headache (MOH). The data show that 72.2% reported taking medications to treat headache episodes, with paracetamol predominating in 50.0% of cases and ibuprofen in 36.4%. Of particular interest is the high percentage of cases (83.5%) with atypical characteristics, reflecting the diagnostic complexity in childhood and the need for more specific criteria for the pediatric population. Univariate analysis revealed statistically significant associations of chronicity with female gender (p = 0.002), a family history of headache (p < 0.001), sleep disturbances, particularly difficulty falling asleep (p < 0.001) nighttime awakenings (p = 0.017), and neuropsychiatric disorders, particularly anxiety disorders (p < 0.001). Univariate analysis for chronicity factors also revealed a statistically significant association with severe headaches (p < 0.001). Multivariate analysis confirmed several factors as independent predictors of headache occurrence, including female gender, a family history of headache, and the presence of sleep disturbances.

Conclusion: In conclusion, headache in childhood is a frequent and potentially disabling clinical condition, especially in its chronic forms. Understanding the risk factors for chronicity and the main comorbidities is also essential for correct diagnosis, appropriate therapeutic and preventive intervention.