When pain meets obsession: Investigating the association between headache and obsessive-compulsive symptoms in a pediatric cohort

Aim: To investigate the prevalence, severity, and clinical correlates of obsessive-compulsive symptoms (OCS) in pediatric patients with primary headache disorders. Methods: In this monocentric, observational, and retrospective study, we assessed 100 children and adolescents (mean age = 12.0 years; 63% female) diagnosed with migraine, tension-type headache (TTH) or coexisting migraine and TTH at a tertiary child neuropsychiatry outpatient clinic. OCS were evaluated using the Obsessive-Compulsive Inventory–Child Version (OCI-CV), with clinically significant symptoms defined as a total score ≥21. A multivariable logistic regression model examined associations with sex, age, and neurovegetative features. A post-hoc power analysis was also conducted. Results: Clinically significant OCS were present in 17% of participants. Female sex (OR = 5.18, 95% CI = 1.24–36.32, p = .046) and the presence of neurovegetative symptoms (OR = 1.51, 95% CI = 1.11–2.08, p = .009) were significant predictors, whereas age showed no significant effect. The most elevated OCI-CV subscales were “Obsessing,” “Hoarding,” and “Ordering.” Conclusion: OCS are relatively common in pediatric patients with primary headache, especially among females and those reporting autonomic symptoms. Routine psychopathological screening in this population may support early identification and targeted clinical management.