Clinical Characteristics and Burden of Primary Headache Disorders in South Indian Children

Primary headache disorders significantly disrupt pediatric populations, with tension-type headaches predominating among children aged 6 to 15 in South Indian hospital settings, according to data published in Cureus. The cross-sectional analysis reveals substantial clinical burdens, including moderate-to-severe pain, academic difficulties, and school absenteeism linked to these neurological conditions.

In Plain English: The Clinical Takeaway

• What was studied: Researchers evaluated 220 children aged 6 to 15 years presenting with recurrent primary headaches at a tertiary-care hospital in Madurai, Tamil Nadu, to understand their symptoms, triggers, and functional impacts.
• Key findings: Tension-type headaches affected half of the cohort, while migraines accounted for roughly 29.5%. Moderate and severe pain were reported by a majority of the children, with many experiencing associated scholastic difficulties and school absenteeism.
• Clinical recommendation: Comprehensive management requires targeted symptom recognition alongside lifestyle evaluations—such as monitoring screen exposure, optimizing sleep, and addressing academic stress—rather than relying solely on medication.

Clinical Distribution and Phenotypes at Velammal Medical College Hospital

The hospital-based cross-sectional study, conducted from September 2023 through August 2025 within the Department of Pediatrics at Velammal Medical College Hospital and Research Institute in Madurai, India, enrolled 220 children using consecutive sampling. Among the participants, the median age stood at 14 years, and 125 participants—representing 56.8% of the cohort—were female. Secondary causes of headaches, such as intracranial lesions, infections, or trauma, were rigorously excluded through structured clinical histories and physical examinations.

Diagnostic classification using the International Classification of Headache Disorders, Third Edition (ICHD-3) framework revealed that tension-type headache was the most common phenotype, occurring in 110 children (50.0%). Migraines followed closely at 29.5% (65 participants), while chronic persistent headache accounted for 10.9% (24 participants), and other primary headache disorders comprised 9.5% (21 participants). Most children—specifically 163 participants, or 74.1%—experienced headache episodes spanning 1 to 15 days per month.

Photo: riss.kr

Headache Phenotype	Participant Count (N = 220)	Percentage (%)
Tension-Type Headache	110	50.0%
Migraine	65	29.5%
Chronic Persistent Headache	24	10.9%
Other Primary Headaches	21	9.5%

Quantifying the Functional and Scholastic Burden of Pediatric Pain

The study utilized the Visual Analog Scale (VAS) to measure pain severity, yielding a mean VAS pain score of 5.28 out of 10 (±1.97). Moderate pain was documented in 122 children (55.5%), and severe pain was recorded in 52 participants (23.6%). To manage these recurring symptoms, 113 children (51.4%) reported regular medication use for headache relief. Accompanying clinical features frequently included visual disturbances, reported by 49 children (22.3%), alongside sensitivity to sound and episodes of nausea or vomiting.

Beyond the physiological toll, the research highlighted considerable functional impairments affecting daily life and education. Reported scholastic difficulties were observed in 119 children (54.1%), accompanied by frequent school absenteeism. Furthermore, lifestyle factors such as digital screen exposure were commonly noted during clinical assessments. Investigators emphasized that screen exposure serves as a lifestyle characteristic requiring careful clinical consideration during evaluation rather than acting as a definitive, isolated determinant of headache severity.

Methodological Design and Sample Size Determination

Analyses investigating associations between headache phenotype and clinical variables, as well as lifestyle factors such as screen exposure and pain severity, functioned as secondary exploratory evaluations that were excluded from initial sample size computations. With the final enrollment reaching 220 participants, a chi-square analysis of a 3 by 4 contingency table maintained approximately 80% power at an alpha level of 0.05 to detect an overall effect equivalent to Cramer’s V of approximately 0.25, indicating that the investigation was better equipped to identify moderate associations rather than small ones.

References

• Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia.
• Systemic reviews and meta-analyses estimating the pooled prevalence of pediatric primary headache disorders.
• Hospital-based cross-sectional data from Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India.