2025 highlights in headache in children and adolescents

Recent advances have reshaped our perception of migraine in children and adolescents, shifting the focus from symptoms and therapies toward a broader view of the young patient as a developing individual. Migraine is no longer seen solely as a neurological disorder but as a complex condition in which biological vulnerability interacts with personal experience and environment. From childhood onward, this interaction unfolds over time, shaping not only the course of migraine but also the broader trajectory of emotional growth and physical health (1).

Within this new conceptual orbit, the child with migraine is not merely a patient to be treated but an individual whose condition reflects the continuous interplay between brain function, behavior, and experience. This perspective broadens the scope of pediatric neurology, encouraging us to view migraine not simply as an episodic event but as part of a dynamic process that evolves with the child.

Several contributions published in 2025 have reinforced this vision (2–7). The paper by Arruda et al. (2), provided a comprehensive overview of psychiatric comorbidities, resilience, and executive functions in children and adolescents with headache, demonstrating that anxiety, depression, and behavioral disorders are not merely comorbid conditions but true modulators of pain and treatment response. At the same time, protective factors, particularly resilience and selected cognitive skills, can mitigate the impact of the disease and foster better adaptation (2).

In the same direction, the study by Bottiroli et al. (3), added an essential piece to understanding the link between early-life experiences and migraine vulnerability. The authors showed that childhood trauma can shape a distinct psychological and clinical profile in adults with migraine, characterized by higher emotional vulnerability, increased stress, and poorer quality of life. This study shifts the focus from the “painful brain” to the “wounded brain,” emphasizing the complex interplay between mind, brain, and environment. Although conducted in adults, the findings are highly relevant for developmental age: early adverse experiences may influence the maturation of neural networks involved in pain and emotion regulation, predisposing individuals to greater nociceptive sensitivity and maladaptive coping patterns (3). Adopting a longitudinal perspective further reveals how psychological and somatic factors progressively interact to shape migraine vulnerability across development. Espanioli et al. (4) demonstrated that pain catastrophizing is a significant longitudinal predictor of migraine-related disability in children and adolescents. Their findings show that the way young patients interpret and respond to pain can influence future functional outcomes independently of attack frequency (4). Further supporting the idea that migraine vulnerability extends beyond cranial pain, Reidy et al. (5) showed that adolescents with migraine frequently report multisite non-cephalic pain, with greater involvement in those with continuous or severe headache. This pattern is consistent with early features of central sensitization and highlights the need to consider broader pain-processing vulnerabilities in pediatric assessment (5).

Recognizing this multidimensional nature of migraine, psychological assessment and empowerment interventions should be integrated into clinical protocols from the earliest stages of the disease. Within this framework, the social dimension of migraine in children and adolescents also emerges as a key element. The European study coordinated by Goadsby et al. (6) highlighted how poor public knowledge about migraine contributes to the persistence of stigma, which often begins in adolescence. The normalization of pain (“it is just a headache”) can lead to underestimation of the condition, affecting self-perception and willingness to seek help. In this sense, the management of migraine extends beyond the patient, encompassing the entire environment in which the child grows (6). Educating parents, teachers, and caregivers to recognize and validate the child's pain is an integral part of care, no less important than pharmacological treatment. Promoting health-education programs and awareness campaigns represents a crucial step toward reducing stigma and encouraging earlier and more accurate diagnoses (3,6). Supporting the child with migraine means nurturing the future adult with migraine. An integrated and longitudinal approach must aim not only to reduce headache frequency but also to enhance resilience, overall functioning, and continuity of care (2–7).

In this regard, an important 2025 contribution came from the Child and Adolescent Committee of the International Headache Society (7), which proposed structured models for the transition from pediatric to adult care. Transition represents a critical yet often neglected phase, when the risk of fragmented care and loss to follow-up is high. The position paper advocates shared pathways between pediatric and adult teams, with progressive involvement of both patients and families. The challenge is to move from a child- and parent-focused model of care to an adult, self-directed one that encourages autonomy and self-management (7).

Taken together, the evidence from 2025 outlines a clear trajectory. Migraine in children and adolescents must be approached through a biopsychosocial and longitudinal perspective (8,9). The coming years should consolidate integrated models of care that bring together neurologists, psychologists, pediatricians, and families. Future research should go beyond the search for new pharmacological options and focus on how psychological, familial, and social factors shape migraine trajectories, integrating digital tools and ecological data to identify early risk and resilience patterns and to design personalized care models (10).

Treating migraine in a child means tracing the orbit that will guide the adult to come, where every intervention, pharmacological, psychological or educational, shapes the trajectory of future health and autonomy (Figure 1).

Figure 1.

Tracing the trajectory of migraine in childhood.