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

Abstract

<b>Background:</b> 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. <b>Methods:</b> 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. <b>Results:</b> 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. <b>Conclusions:</b> 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.