High CSSI-24 scores in paediatric headache suggest a functional disorder and call for a neurodevelopmental biopsychosocial framework: A prospective cohort study.

BACKGROUND AND

OBJECTIVES

Primary headache is the most frequent neurological symptom in childhood and often coexists with psychosomatic risk factors. This study investigated functional (psychosomatic) features and anxiety in children and adolescents with primary headache, testing the hypothesis that a subgroup with high Children's Somatic Symptoms Inventory (CSSI-24) scores may present characteristics consistent with a functional disorder.

METHODS

In this prospective observational cohort study, 148 patients aged >6 years with primary headache, diagnosed according to ICHD-3 criteria by child neurologists at a tertiary hospital, were enrolled. Demographic and clinical data, psychosomatic risk factors, and anxiety were collected through interviews and validated questionnaires. Patients were stratified using the CSSI-24 into Group 1 (<19: low psychosomatic score) and Group 2 (≥19: high psychosomatic score). Associations between functional symptoms , anxiety, and headache characteristics were analysed.

RESULTS

Overall, 42.6% of participants had CSSI-24 ≥ 19. Compared with Group 1, Group 2 included more females (p = 0.046), were older (p = 0.013), and reported greater pain intensity (p = 0.02), higher monthly headache frequency (p = 0.04), and more frequent chronic analgesic use (p = 0.012). They also showed multiple psychosomatic risk factors (p = 0.04), severe somatic symptoms across several systems (p < 0.001), and higher anxiety levels (p < 0.001).

CONCLUSIONS

The identification of high CSSI-24 scores in a subgroup of children with primary headache could have implications for the conceptual model of pediatric headache and supports integrating neurodevelopmental and biopsychosocial perspectives. Early recognition of a "functional" phenotype may guide personalized, multidisciplinary interventions addressing stress, anxiety, and maladaptive behaviour.