Disparities in Headache Care and Research in Children and Adolescents: A Narrative Review.

PURPOSE OF REVIEW: Headache disorders are highly prevalent in children and adolescents and represent a significant source of disability during developmental years. Despite this, disparities in pediatric headache care and research remain insufficiently characterized. This narrative review synthesizes current evidence on inequities across epidemiology, diagnosis, treatment access, and research participation. RECENT FINDINGS: Migraine and tension-type headache contribute substantially to years lived with disability in the pediatric population, with rising absolute burden over time. Important gaps persist between prevalence and formal diagnosis. Underdiagnosis is more common among younger children and among those from lower socioeconomic backgrounds, immigrant families, and marginalized racial and ethnic groups. Structural determinants, including insurance status, geographic maldistribution of specialists, language barriers, and limited caregiver health literacy, contribute to delayed diagnosis and fragmented care. Psychosocial stressors, adverse childhood experiences, discrimination, and pain-related stigma further influence headache frequency, disability, and healthcare engagement. Disparities also extend into pediatric headache research. Racial and ethnic minorities and non-English-speaking families remain underrepresented in clinical trials. Methodological challenges, including high placebo response rates and limited validation of patient-reported outcome measures in diverse populations, complicate evidence generation. Although telehealth and digital tools may expand access, unequal digital infrastructure may also reinforce existing inequities. Reducing differences in pediatric headache requires coordinated policy reform, strengthened primary care capacity, and developmentally informed transition planning. Centering equity in pediatric headache care is essential to improving long-term neurologic and psychosocial outcomes.