Beyond the Pain: A Critical Examination of the Psychopathological and Neuropsychological Dimensions of Primary Headaches in Pediatric Populations.

Background

Primary headaches in children and adolescents impose emotional, cognitive, and functional burdens beyond pain. This review synthesizes their psychopathological and neuropsychological dimensions and outlines implications for assessment and care.

Methods

We performed a comprehensive review with systematic searches of PubMed, Scopus, and Embase (2015-2025). We included observational/experimental studies and evidence syntheses on 0-18-year-olds with migraine, tension-type, or cluster headache; treatment-only reports were excluded.

Results

Across population and clinic samples, primary headaches co-occur with elevated anxiety/depression, frequent ADHD/learning problems, and pervasive sleep disturbances with likely bidirectionality. Interictally, small to moderate neurocognitive differences are most consistent in attention/executive control, processing speed, and verbal memory. Quality of life and school participation are reduced. Standardized tools (e.g., PedMIDAS, PedsQL/KIDSCREEN, SDQ/CBCL, SDSC±actigraphy, NEPSY-II/BRIEF) support multidisciplinary assessment.

Conclusions

Care should look beyond pain counts, integrating routine screening of mood, sleep, and cognition; active family involvement; and school-healthcare coordination within stepped-care pathways (education and sleep hygiene for all; targeted CBT for catastrophizing/avoidance) with monitoring that pairs headache frequency with functional outcomes.