{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T03:58:21Z","timestamp":1790913501703,"version":"4.1.0"},"reference-count":26,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T00:00:00Z","timestamp":1759536000000},"content-version":"vor","delay-in-days":276,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatrics International"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Headaches in children are caused by a variety of factors. Despite the numerous reports on secondary headache in the emergency department, details on pediatric headache outpatients are scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed the medical records of patients who first visited our outpatient headache clinic between May 2022 and October 2023 and were considered to have secondary headache.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty\u2010seven of 68 patients (39%) were diagnosed as having secondary headache as the main illness. The gender breakdown of 20 boys and 7 girls represented a significant difference. Patient age range was 5\u201317\u2009years (median: 13\u2009years and 8\u2009months), and a family history of headache was noted in 20 patients (74%). Headache frequency was described as \u201calmost daily\u201d in 18 patients (67%). The main diagnosis of secondary headache was psychiatric disorders (social anxiety disorder; SAD) in 13 patients, homeostatic disorders (orthostatic dysregulation; OD) in 9 patients, facial organ\u2010related headache (FORH) in 3 patients, and nonvascular intracranial disease in 2 patients. Comorbidities included autism spectrum disorder (ASD) in 18 patients and school refusal (SR) in 8 patients. Nine of the ASD patients were diagnosed after their headache outpatient visit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our analysis of secondary headache patients in a tertiary facility revealed that roughly half of the patients had SAD, all of whom harbored ASD as a comorbidity. Many of the patients were adolescents, which coincided with the age of OD onset. When examining pediatric secondary headache patients, extra attention is warranted to developmental characteristics, particularly those of adolescents.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ped.70226","type":"journal-article","created":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T07:03:32Z","timestamp":1759561412000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Secondary headache in an outpatient headache clinic at a pediatric tertiary care facility"],"prefix":"10.1111","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4733-0253","authenticated-orcid":false,"given":"Tsukasa","family":"Higuchi","sequence":"first","affiliation":[{"name":"Department of General Pediatrics Nagano Children's Hospital  Azumino Japan"},{"name":"Life Science Research Center Nagano Children's Hospital  Azumino Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayako","family":"Kanai","sequence":"additional","affiliation":[{"name":"Department of General Pediatrics Nagano Children's Hospital  Azumino Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiko","family":"Okita","sequence":"additional","affiliation":[{"name":"Department of General Pediatrics Nagano Children's Hospital  Azumino Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,4]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10194-008-0042-x"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11916-020-00892-6"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/ped.70031"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1332743"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2019.00886"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-010-0279-4"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-018-0865-z"},{"key":"e_1_2_8_9_1","first-page":"161","article-title":"Secondary headache experienced in hospital pediatrics","volume":"49","author":"Nishimura A","year":"2022","journal-title":"Jpn J Headache"},{"key":"e_1_2_8_10_1","first-page":"612","article-title":"Characteristics of headache patients in an outpatient setting at a tertiary pediatric facility","volume":"50","author":"Higuchi T","year":"2024","journal-title":"Jpn J Headache"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2012.244"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/ped.15406"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci14100951"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/ped.15181"},{"key":"e_1_2_8_15_1","unstructured":"ORCD.Data explorer. 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