Primary headache with onset in childhood and adolescence: natural history and prognostic factors in a Portuguese population

Headaches are the most frequent neurological disorder in the pediatric population, with big impact on quality of life. Objectives: This study aims to characterize a cohort of patients followed at a Pediatric Neurology Unit between January 1st 2013 and December 31st, 2021. Methods: We retrospectively reviewed the medical records and selected patients with primary headaches with a minimum follow-up of 12 months. Results: A total of 226 patients were included (females 54.4%), with an average age of headache onset of 9.6 ± 3.8 (1.5-17.7) years, 53.3% prepubertal. A positive family history of headache was identified in 76.6% of the cases and triggers in 63.6%. At first clinical assessment, 45.1% were classified as migraine without aura and 10.6% with aura, 3.5% tension-type, 8.0% mixed tension and migraine, 1.3% other type and 31.4% were unclassifiable. The patients had a median follow-up of 2.4 (1.8-3.3) years. The diagnosis of tension-type headaches remained stable in 75% of the patients and resolved in 25%; 13.0% patients with migraine without aura changed into another type of headache and 17.4% resolved; 44.4% of the patients with migraine with aura turned into another type of headache and 11.1% resolved. Of the variables studied, only duration of each headache episode had a significant association with headache remission, with OR 0.16 (p=0.03, 95% CI 0.032-0.84). Conclusions: Our study shows that patient type of headache changes over time, especially in those having migraine with aura. The duration of each headache episode was presented as a predictor of headache remission over time.
Keywords: primary headache, childhood, adolescence, natural history