Secondary headache in an outpatient headache clinic at a pediatric tertiary care facility.

Background: Headaches in children are caused by a variety of factors. Despite the numerous reports on secondary headache in the emergency department, details on pediatric headache outpatients are scarce.

Methods: We retrospectively reviewed the medical records of patients who first visited our outpatient headache clinic between May 2022 and October 2023 and were considered to have secondary headache.

Results: Twenty-seven of 68 patients (39%) were diagnosed as having secondary headache as the main illness. The gender breakdown of 20 boys and 7 girls represented a significant difference. Patient age range was 5-17 years (median: 13 years and 8 months), and a family history of headache was noted in 20 patients (74%). Headache frequency was described as "almost daily" in 18 patients (67%). The main diagnosis of secondary headache was psychiatric disorders (social anxiety disorder; SAD) in 13 patients, homeostatic disorders (orthostatic dysregulation; OD) in 9 patients, facial organ-related headache (FORH) in 3 patients, and nonvascular intracranial disease in 2 patients. Comorbidities included autism spectrum disorder (ASD) in 18 patients and school refusal (SR) in 8 patients. Nine of the ASD patients were diagnosed after their headache outpatient visit.

Conclusion: Our analysis of secondary headache patients in a tertiary facility revealed that roughly half of the patients had SAD, all of whom harbored ASD as a comorbidity. Many of the patients were adolescents, which coincided with the age of OD onset. When examining pediatric secondary headache patients, extra attention is warranted to developmental characteristics, particularly those of adolescents.