Primary Headache in Children: Clinical Characteristics and Impact on School Functioning in a Low-Resource Country

Primary headaches in children impair daily functioning, yet data from Jordan, particularly regarding their effect on school functioning, have not been systematically evaluated. The objective of this study is to assess the clinical characteristics of pediatric primary headaches in central Jordan and their association with school functioning. A cross-sectional study included children aged 5 to 18 years diagnosed with primary headaches at three public hospitals. Data were collected using a structured, culturally adapted questionnaire incorporating items from the validated Arabic PedsQL 4.0 school-functioning scale. Descriptive, univariable, and multivariable analyses were performed to identify factors associated with impaired school functioning. A total of 147 children were included (51% male; 61.2% aged 10–14 years). Migraine was most common (60.5%), followed by tension-type headache (23.8%). Common triggers included stress, noise, and sleep disturbance. Unfavorable lifestyle factors—increased screen time, skipped meals, low hydration, and limited physical activity—were prevalent. More than 92% of participants had impairment in at least one school-functioning domain. Poor academic performance and lower parental education were significantly associated with lower scores. In multivariable analysis, poorer academic performance and lower paternal education remained independently associated with worse school-functioning scores, whereas headache type and frequency were not significant predictors. Most patients used simple analgesics (paracetamol in 93%), whereas migraine-specific rescue medications and preventive therapies were rarely used. Primary headaches in children are associated with substantial impairment in school functioning. Educational and family-related factors appear more influential than headache-specific variables. Addressing modifiable lifestyle and contextual factors may improve outcomes.