Headache and Pain Research

Original Article

Diagnostic Spectrum of Orthostatic Intolerance and Otologic Diseases in Pediatric Patients with Primary Headache and Dizziness: A Single-Center Retrospective Study: Hey-Joon Son, Kon-Hee Lee; Headache Pain Res. 2026;27(2):158-164. Published online June 30, 2026; DOI: https://doi.org/10.62087/hpr.2026.0021

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Abstract PDF: Purpose: Dizziness frequently coexists with headache in children and adolescents, but its diagnostic significance is often underrecognized. Orthostatic intolerance (OI) and otologic diseases are major causes of pediatric dizziness, yet distinguishing among these conditions remains clinically challenging. This study examined the diagnostic distribution of OI and otologic diseases in pediatric patients with primary headache-associated dizziness.
Methods
We retrospectively reviewed 310 patients aged 7–18 years who presented with both headache and dizziness; patients with secondary headache disorders were excluded. OI was assessed using head-up tilt testing and was classified primarily as orthostatic hypotension (OH) or postural orthostatic tachycardia syndrome (POTS). Otologic diseases, mainly peripheral vestibular disorders, were identified by otolaryngologists. Statistical analyses included the chi-squared test and one-way analysis of variance.
Results
The most common headache subtypes were migraine without aura (42.9%), vestibular migraine (15.8%), and tension- type headache (15.2%). OI was identified in 63.9% of patients, including OH in 40.6% and POTS in 23.2%; otologic diseases were present in 20.0%. The distributions of OI and otologic diseases did not differ significantly by headache subtype. OI was significantly associated with age and sex, with the POTS group having the highest mean age and a marked female predominance. Age also differed significantly across otologic disease subtypes.
Conclusion
In pediatric patients with headache and dizziness, OI and otologic diseases were common but were not associated with headache subtype. Instead, diagnostic patterns were more closely related to age and sex, suggesting that developmental and demographic factors should be considered when evaluating headache-associated dizziness in this population.

Review Articles

Headache as a Somatic Symptom in Pediatrics: Diagnosis and Integrated Management: Hye Eun Kwon; Headache Pain Res. 2025;26(3):193-199. Published online October 20, 2025; DOI: https://doi.org/10.62087/hpr.2025.0016

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Somatization—the expression of psychological distress through physical symptoms—presents a frequent and complex challenge in pediatric practice. Headache and dizziness are among its most common manifestations. This review addresses the diagnostic challenge of determining whether these symptoms indicate a primary headache disorder or reflect somatic symptom presentations. The difficulty becomes particularly evident when conditions manifest in severe or persistent forms, such as chronic primary headache (CPH) and somatic symptom and related disorders (SSRD), where clinical overlap is considerable and coexistence may occur. We first explore the shared pathophysiological mechanisms, emphasizing central sensitization as a unifying process. We then propose a clinical framework for differential diagnosis that includes careful evaluation of predisposing risk factors and contrasts the defined diagnostic criteria of CPH with the maladaptive psychological responses frequently observed in SSRD. Management strategies diverge pharmacologically but converge on key non-pharmacological approaches. For primary headaches, pharmacotherapy is primarily used for prophylaxis, although its efficacy remains limited in pediatric trials. In contrast, for somatic presentations, medication typically serves as an adjunctive treatment targeting comorbidities, while psychotherapy (particularly cognitive behavioral therapy [CBT]) functions as the cornerstone of care. Non-pharmacological interventions such as CBT and biofeedback are essential for improving functioning across both conditions. Therefore, effective management relies on a framework of comprehensive psychoeducation, holistic assessment, and integrated interdisciplinary care.

Citations

Citations to this article as recorded by

Pediatric Headache in Korea: Beyond a Common Complaint to a Chronic Neurological Condition
Yun Jin Lee
Headache and Pain Research.2026; 27(1): 4. CrossRef

Vestibular Migraine: Challenges in Diagnosis and Management: Byung-Kun Kim; Headache Pain Res. 2025;26(2):106-115. Published online June 11, 2025; DOI: https://doi.org/10.62087/hpr.2025.0001

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2 Citations

Abstract PDF

Vestibular migraine (VM) remains a clinical challenge due to its heterogeneous presentation and the frequent absence of typical migraine features during vestibular episodes. Although many studies have adopted the diagnostic criteria defined by the International Classification of Headache Disorders (ICHD), interpretation of findings is often complicated by variability in how these criteria are applied across studies. VM is frequently underdiagnosed or misdiagnosed, owing to its clinical overlap with other vestibular disorders. This review provides a comprehensive overview of the epidemiology, diagnostic criteria, differential diagnosis, and treatment strategies for VM. Particular emphasis is placed on distinguishing VM from other causes of vertigo to support accurate diagnosis and tailored management. By synthesizing current evidence, this review aims to improve clinical recognition, diagnostic precision, and therapeutic outcomes for patients with this under-recognized and often debilitating condition.

Citations

Citations to this article as recorded by

Vestibular Evoked Myogenic Potential in Vestibular Migraine: A Systematic Review of Diagnostic Utility
Mayur Bhat, Krithi Rao, Sinchana Hegde, Kaushlendra Kumar, Aditya Khandagale, KM Prajwal, Shezeen Abdul Gafoor
Audiology Research.2026; 16(1): 11. CrossRef
Toward Precision Migraine Care: Genetics, Symptoms, and Big-Data-Driven Approaches
Soo-Jin Cho
Headache and Pain Research.2025; 26(3): 171. CrossRef

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