Clinical, Biochemical, Lifestyle, and Sleep Characteristics Associated With Chronic Primary Headache in Children and Adolescents: A Cross-Sectional Comparative Study

Abstract

Chronic primary headache in childhood causes substantial functional impairment and may involve interacting clinical, familial, biochemical, lifestyle, and sleep-related factors. This cross-sectional comparative study evaluated factors independently associated with chronic headache status in 300 participants aged 6–18 years, including 200 with chronic and 100 with episodic primary headache. Headache characteristics, family history of migraine, serum 25-hydroxyvitamin D, vitamin B12 and ferritin levels, Pittsburgh Sleep Quality Index scores, and actigraphy-derived sleep and physical activity parameters were assessed. Binary logistic regression was performed, while EEG findings were descriptively evaluated in a clinically selected subgroup. Compared with the episodic group, participants with chronic headache had poorer subjective and objective sleep characteristics, lower vitamin D, vitamin B12 and ferritin levels, and less daily physical activity (all p<0.01). Subjective sleep duration <7 hours/night (adjusted OR [aOR]=3.24), PSQI score >8 (aOR=2.91), vitamin D <20 ng/mL (aOR=2.17), physical activity <30 minutes/day (aOR=1.98), and family history of migraine (aOR=2.83) were independently associated with chronic headache status. In the objective sleep model, sleep efficiency <85% (aOR=3.07), wake after sleep onset >40 minutes/night (aOR=2.48), and total sleep time <7 hours/night (aOR=2.91) remained independently associated with chronic headache, alongside low vitamin D status and physical activity. EEG abnormalities were unrelated to headache intensity (p>0.05). These findings support multidimensional assessment of pediatric chronic headache, although causality cannot be inferred from the cross-sectional design.