Ambulatory Blood Pressure Profiles in Children With Primary Headache Disorders Despite Normal Office Blood Pressure

Headache is a common complaint in children and may indicate early hypertension (HT), an emerging concern in pediatrics. Children with primary headache (PH) may exhibit elevated blood pressure (BP) load or impaired nocturnal dipping despite normal office BP. This study aimed to evaluate the utility of ambulatory blood pressure monitoring (ABPM) in children with PH.

A case-control study was conducted including 37 children aged 8-17 years diagnosed with PH according to the International Classification of Headache Disorders (ICHD-3) criteria, all with office BP below the 95th percentile. Thirty-seven age- and sex-matched healthy subjects served as controls. Demographic, office BP, and ABPM parameters were compared between groups.

Of the PH group, 81% (n = 30) had migraines and 19% (n = 7) had tension-type headache. No significant differences were found between groups regarding age, BMI SDS, or office systolic BP SDS. However, ABPM revealed significantly higher total, daytime, and nocturnal systolic BP, and increased nocturnal systolic and diastolic BP loads in the PH group (all p < 0.05). No differences were noted between headache subtypes.

Children with PH may exhibit increased BP loads and disrupted BP patterns despite normal office measurements. ABPM appears to be a useful tool for accurately detecting subtle BP alterations in this population.