This observational retrospective cohort study aims to identify clinical and biochemical predictors of response to propranolol prophylaxis in pediatric migraine. A total of 178 children diagnosed with migraine between 2021 and 2023 were evaluated based on headache-related disability (PedMIDAS) and pain severity (VAS). Patients were treated either with behavioral therapy or propranolol (1-3 mg/kg/day) for 3 months.

Migraine is a common and disabling neurological condition in the pediatric population, often requiring prophylactic treatment to reduce attack frequency and improve quality of life. Propranolol is frequently prescribed for pediatric migraine prevention; however, treatment response varies considerably among individuals. Understanding the clinical and biochemical factors that predict treatment efficacy could enhance individualized care and reduce unnecessary medication use.

This retrospective cohort study evaluated 178 children diagnosed with pediatric migraine between January 2021 and December 2023 at a tertiary neurology outpatient clinic. All participants were assessed using the Pediatric Migraine Disability Assessment Scale (PedMIDAS) and Visual Analog Scale (VAS) before and after treatment. Patients received either behavioral therapy or oral propranolol (1-3 mg/kg/day) for a duration of 3 months, based on clinical indication and family preference.

Inclusion Criteria:

• Children aged 0-20 years
• Diagnosed with primary headache according to the International Classification of Headache Disorders, 3rd edition (ICHD-3)
• Clinical and/or neurological evaluation consistent with primary headache
• Completed baseline PedMIDAS and VAS assessments
• Available for 3-month follow-up after initiation of treatment

Exclusion Criteria:

• Diagnosis of secondary headache, based on clinical history, family history, neurological examination, or laboratory/imaging findings
• Failure to meet ICHD-3 diagnostic criteria for primary headache
• Presence of structural brain lesions or other neurological disorders
• Chronic systemic illness or current use of other migraine prophylactic medications
• Incomplete data or loss to follow-up within the 3-month period

The study population consisted of pediatric patients aged [2-19] who were diagnosed with primary headache disorders, specifically migraine, according to the International Classification of Headache Disorders, 3rd edition (ICHD-3). Participants were evaluated and followed at the pediatric neurology outpatient clinic of a tertiary care hospital between January 2021 and December 2023. Patients with confirmed comorbid conditions (e.g., anxiety, benign paroxysmal vertigo, essential tremor) and/or vitamin deficiencies were included to assess the impact of these factors on treatment response. Those with secondary headache, neurological disorders, or incomplete records were excluded.