Patient reported trigger, not the speed of transition to continuous headache, is associated with headache-related disability in children: Results of a cross-sectional clinic-based study

ObjectiveTo investigate the relationship between the evolution of continuous headache and headache-related disability in children.MethodsThis was a single site cross-sectional study using patient-entered questionnaires from children aged 6-17 who presented to neurology clinic between November 2022-May 2024 with continuous headache. Participants were categorized as sudden onset (no evolution), rapidly evolved (< 3 months), or gradually evolved (≥ 3 months) continuous headache. Analysis examined the relationship between the pattern of headache evolution and headache-related disability (PedMIDAS score), accounting for demographic, headache characteristic, and onset factors.ResultsOf 751 respondents, 42.5% reported sudden onset, 35.0% rapid evolution, and 22.5% gradual evolution to continuous headache. There was no significant difference in PedMIDAS score in children who reported sudden onset compared to children with rapid (6.9 [-2.7, 16.4], p = 0.159) or gradual evolution (10.3 [-0.8, 21.3], p = 0.068) of headache onset. Older age (3.3 per year [1.8, 4.8], p < 0.001) and patient reported trigger (17.1 [8.8, 25.5], p < 0.001) at the onset of continuous headache were both associated with greater headache-related disability, accounting for other covariates.ConclusionChildren transitioned to continuous headache quickly, consistent with prior studies. Older children and those who associated onset of continuous headache with a trigger reported higher rates of headache-related disability.