Pediatric migraine: Neurodevelopmental mechanisms, clinical phenotypes, and modern therapeutics

Table 2 Key clinical features differentiating pediatric headache types

Feature	Migraine	Tension-type headache	Secondary headache
Typical onset	Episodic, recurrent	Gradual, often stress-related	Acute or progressive
Pain quality	Pulsating/throbbing	Pressing/tight	Variable
Pain location	Bilateral (frontotemporal) in children	Bilateral, diffuse	Often focal or occipital
Intensity	Moderate to severe	Mild to moderate	Variable, often severe
Activity worsens pain	Yes	No	Variable
Nausea/vomiting	Common	Absent	Possible
Photo-/phonophobia	Common	Absent or mild	Variable
Autonomic features	Common in children	Rare	Possible
Neurological exam	Normal	Normal	Often abnormal
Response to sleep	Marked improvement	Minimal effect	Poor or absent