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

This study looked at children with headaches caused by other health conditions. Of 68 children seen at a headache clinic, 39% had headaches linked to other problems like anxiety or blood pressure issues. Most were teenage boys with daily headaches. Importantly, two-thirds had autism, and many weren't diagnosed with autism until after seeking help for headaches. This suggests headaches might be an early sign that leads to autism diagnosis.

This retrospective study examined 68 pediatric patients attending an outpatient headache clinic, finding 39% had secondary headaches (headaches caused by underlying conditions). The most common causes were psychiatric disorders, particularly social anxiety disorder (48%), and homeostatic disorders like orthostatic dysregulation (33%). Notably, 67% of secondary headache patients had autism spectrum disorder as a comorbidity, with one-third diagnosed with autism only after their headache visit. The majority were adolescent boys experiencing near-daily headaches with strong family histories.

The study highlights the important connection between autism, anxiety disorders, and headache presentation in pediatric populations.

Clinicians should consider autism screening in pediatric patients presenting with headaches, particularly adolescent males with daily symptoms. The high prevalence of psychiatric comorbidities suggests need for multidisciplinary assessment including mental health evaluation in pediatric headache clinics.

Single-center retrospective study with small sample size (n=68). Limited generalizability due to tertiary care setting. No comparison group or control data. Study design cannot establish causal relationships between autism and headache presentation.

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. 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. 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. 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.