Consultation Lag and Early Improvement in Pediatric Daily Headache: A Retrospective Observational Study

Pediatric daily headaches are refractory and disabling. However, the influence of the interval between daily headache onset and initial specialist consultation on clinical outcomes remains unknown.

This retrospective observational study included 51 children and adolescents presenting with daily headaches. Consultation lag was defined as the interval between the date when the headache first became daily and the initial consultation. The primary outcome was headache improvement (≥50% reduction in monthly headache days) at 3-4 months, and the secondary outcome was improvement at 6-7 months. Multivariate logistic regression and receiver operating characteristic curve analyses were performed.

Improvements were observed in 41.2% of patients at 3-4 months and 60.0% at 6-7 months. Each additional week of consultation lag was associated with a 12% decrease in the odds of a 3-4-month improvement (adjusted odds ratio, 0.875; 95% confidence interval [CI], 0.783-0.979; p = 0.020). Receiver operating characteristic curve analysis identified an exploratory 5-week threshold (area under the curve, 0.837; 95% CI, 0.711-0.963), with markedly lower odds of early improvement when exceeding this threshold in this cohort (adjusted odds ratio, 0.040; 95% CI, 0.007-0.238; p < 0.001). Comorbid postural orthostatic tachycardia syndrome was associated with the absence of 3-4-month improvement (p = 0.003), whereas other comorbidities were not.

A shorter consultation lag was independently associated with early improvement in pediatric daily headaches regardless of comorbidities. Patients presenting within this exploratory 5-week window were substantially more likely to improve early in this cohort; however, this threshold requires prospective external validation before it can inform clinical decision-making. These findings support consideration of prompt specialist referral following the onset of daily headache in children.