it negatively influences the child 's quality of life and is an important cause of absence from school and also a significant factor in health - related costs among children and adolescents .
its prevalence varies greatly from 5.9 to 82% , depending on the definition criteria and the age of the patients .
the international headache society classifies headaches into primary and secondary type in classification of headache disorders 2 edition ( ichd - ii ) .
primary headache is not attributed to any other disorder . in the majority of patients with primary headache , general and neurological examinations are normal and
primary headaches include migraine , tension - type headache , cluster headache , autonomic cephalalgias and other primary headache disorders .
frequency of headache increases with age in this population . in the present study we aimed to determine epidemiologic characteristics and compare socioeconomic and some clinical factors related to primary headaches in children / adolescents ( 4 - 15 year olds ) presented to neurology clinics of tabriz university of medical sciences .
the institutional review board at tabriz university of medical sciences approved the study protocol . after obtaining a written informed consent from parents , children with 4 - 15 years of age and with the diagnosis of primary headache ( migraine or tension - type headaches ) who presented to the neurology clinics affiliated to tabriz university of medical sciences , tabriz , iran from march 2009 to october 2011 were included in this cross - sectional study .
a total of 190 patients fulfilled the criteria for enrollment in the study and their demographics were collected .
we noted the type of headache , history of atopy , asphyxia during labor ( according to the history of admission in the neonatal intensive care unit after birth due to respiratory problems based on the parents report and review of the previous medical records ) and breast feeding , family history of headache , presence of headache triggers and the socioeconomic status of the family .
diagnosis of migraine and tension - type headache was based on the international headache society diagnostic criteria for the primary headache disorders .
socioeconomic status was determined according to the total monthly family income ( < 7,000,000 rl vs = 7,000,000 rl ) based on the index of statistical center of iran for grand cities in the years of study in addition to the highest level of education of the father ( < or = high school vs. > or = college ) .
statistical analysis was conducted with spss , version 16.0 for window ( spss , chicago , il ) .
data were expressed as meansd for quantitative variables and as numbers and percentages for categorical variables .
statistical analysis was performed using the chi - square test for categorical variables and the student 's t test for numerical variables .
eighty eight patients ( 46.3% ) had migraine and 102 patients ( 53.7% ) had tension - type headache .
the distributions of gender and age groups in patients with migraine or tension - type headache are shown in table 1 . 
 
the distributions of gender and age groups in patients with migraine or tension - type headache data are presented as numbers no significant differences were seen in the distribution of gender between the patients with migraine and tension - type headache .
migraine and tension - type headache had comparable frequency in different age groups of male patients ( p=0.1 and 0.07 , respectively ) .
in female patients the frequencies of both migraine and tension - type headache were significantly higher in the age group of 10 - 15 years as compared to the age group of 4 - 9 years ( p=0.03 and 0.04 , respectively ) .
there was no significant differences regarding the prevalence of migraine or tension type headache between different genders in the same age group .
the most common clinical presentations of aura in patients with migraine are demonstrated in table 2 .
the comprehensive data regarding the epidemiologic characteristics of patients with migraine or tension - type headache in our study group are shown in table 3 . 
 
the clinical presentations of aura in patients with migraine the characteristics compared between patients with migraine and tension - type headache as triggering factors for headache ; or : odds ratio ; ci : confidence interval history of asphyxia during labor was more prevalent among patients with migraine as compared to the tension - type headache ( p=0.007 , or = 3.24 ) . history of headache in parents was also significantly higher in patients with migraine as compared to tension - type headache ( p=0.001 , or = 3.19 ) .
moreover , the prevalence of atopy was significantly higher in patients with migraine ( p=0.01 , or = 5.70 ) .
prevalence of feeding with formula during infancy did not differ between the patients with either migraine or tension - type headache ( p=0.9 ) .
the low socioeconomic status was more prevalent in patients with migraine headache ( p=0.003 , or = 2.38 ) .
in our study primary headache was more common in older age group which is consistent with danold 's findings which showed that frequency of headache increases with age .
tension type headache in patients was more frequent than migraine which is comparable with findings of kroner - herwig et al .
the main finding in the present study was that gender can not predict the type of primary headache in younger children , as no gender differences were seen between the patients with migraine or tension - type headache in the age group 4 - 9 years .
this finding is in contrast to previous report by krner - herwig et al which showed that being female was a significant predictor for three main subtypes of primary headaches
a few other studies showed that the prevalence of migraine was higher in the males .
our results also demonstrated that the frequencies of migraine and tension - type headache were comparable in different age groups of male patients , whereas female patients in the age group 10 - 15 years had higher frequency of both types of headache especially migraine as compared to the age group 4 - 9 years .
this finding reveals that female adolescents had higher risk for developing primary headache specially migraine as compared to female children .
these results agree with those reported by krner - herwig et al who showed that children with migraine were significantly older than children in the other groups .
it could be due to hormonal effect as the trigger of migraine headache in the female adolescents .
it was previously shown that primary headache in children is closely related to history of headache in their parents .
our results demonstrated that when a parent showed combined headache , the risk of developing migraine in his or her child is more conspicuous as compared to the tension - type headache .
this finding is consistent with previous reports by fallahzadeh et al and krner - herwig et al which showed a stronger association between family history of headache and being afflicted by migraine as compared to tension - type headache in children .
our study also demonstrated that if the patients with history of peripartum asphyxia would develop primary headache it would more probably be of migraine type .
these results partly agree with those reported by maneyapanda et al who found an association between chronic migraine headache and significant perinatal insult due to neuroplasticity and its induced hyperexcitability .
however , it is recommended to design prospective studies to compare the frequency of primary headache ( either migraine or tension - type headache ) in patients with or without perinatal insults to elucidate the role of peripartum asphyxia as a risk factor for developing primary headaches .
we also showed that atopy is more prevalent in patients with migraine as compared to tension - type headache .
also ozge et al found an association between atopy and both migraine and episodic tension - type headaches .
it has been shown that alteration in several interleukins occurs in migraine which supports an association between migraine and atopic disorders .
although it was shown by pogliani et al that breast feeding has a protective role against primary headache disorders , our results showed that children and adolescents with history of formula feeding during infancy have comparable prevalence of developing either migraine or tension - type headache .
our results showed that socioeconomic status of the patients could significantly influence the frequency of migraine in comparison to tension - type headache .
ayzenberg et al in a study on 2725 adults in russia , showed that low socioeconomic status is associated with higher frequency of primary headache disorders .
moreover , katsarava et al in another study on 1145 adult patients in the republic of georgia showed that low socioeconomic status and female gender are risk factors for development of migraine , not tension - type headache .
moreover , the possible role of psychological factors and behavioral characteristics influencing primary headaches could have been considered .
while some variables have been checked by the present report , further prospective studies with larger sample sizes are needed to provide more comprehensive data regarding associated factors in childhood primary headache .
 objectiveheadache is one of the most common neurologic problems in children and adolescents . 
 primary headache including migraine and tension - type headache comprises the vast majority of headaches and are associated with marked incidence , prevalence , and individual and social cost . 
 we aimed to assess demographic characteristics and to compare some factors related to primary headaches in children/ adolescents presented to neurology clinics of tabriz university of medical sciences.methodschildren from 4 to 15 years of age with the diagnosis of primary headache ( migraine or tension - type headaches ) who presented to the neurology clinics affiliated to tabriz university of medical sciences , tabriz , iran from march 2009 to october 2011 are included in this cross - sectional study . 
 data regarding the type of headache , history of atopy , peripartum asphyxia , and breast feeding , family history of headache and the socioeconomic status of the family were collected . 
 the diagnosis was based on the international headache society diagnostic criteria for the primary headache disorders.findingsone hundred ninety children ( 107 females ) with primary headache ( 88 patients with migraine and 102 patients with tension type headache ) enrolled in the study . 
 peripartum asphyxia , history of atopy , family history of headache and low socioeconomic status ( ses ) were more common in patients with migraine ( p - values : 0.007 , 0.01 , 0.001 , 0.003 ; respectively).conclusionphysicians need to extent their knowledge regarding the primary headaches . 
 peripartum asphyxia , history of atopy , headache in parents and low ses have been shown in the present study to be more prevalent in patients with migraine as compared to tension - type headache . 
Introduction
Subjects and Methods
Findings
Discussion
Conclusion
Conflict of Interest