Diagnostic Spectrum of Orthostatic Intolerance and Otologic Diseases in Pediatric Patients with Primary Headache and Dizziness: A Single-Center Retrospective Study

Purpose: Dizziness frequently coexists with headache in children and adolescents, but its diagnostic significance is often underrecognized. Orthostatic intolerance (OI) and otologic diseases are major causes of pediatric dizziness, yet distinguishing among these conditions remains clinically challenging. This study examined the diagnostic distribution of OI and otologic diseases in pediatric patients with primary headache-associated dizziness.Methods: We retrospectively reviewed 310 patients aged 7–18 years who presented with both headache and dizziness; patients with secondary headache disorders were excluded. OI was assessed using head-up tilt testing and was classified primarily as orthostatic hypotension (OH) or postural orthostatic tachycardia syndrome (POTS). Otologic diseases, mainly peripheral vestibular disorders, were identified by otolaryngologists. Statistical analyses included the chi-squared test and one-way analysis of variance.Results: The most common headache subtypes were migraine without aura (42.9%), vestibular migraine (15.8%), and tension- type headache (15.2%). OI was identified in 63.9% of patients, including OH in 40.6% and POTS in 23.2%; otologic diseases were present in 20.0%. The distributions of OI and otologic diseases did not differ significantly by headache subtype. OI was significantly associated with age and sex, with the POTS group having the highest mean age and a marked female predominance. Age also differed significantly across otologic disease subtypes.Conclusion: In pediatric patients with headache and dizziness, OI and otologic diseases were common but were not associated with headache subtype. Instead, diagnostic patterns were more closely related to age and sex, suggesting that developmental and demographic factors should be considered when evaluating headache-associated dizziness in this population.