Abstract
<title>Abstract</title> <p> <bold>Background:</bold> Headache disorders are common during adolescence and may substantially affect school performance, daily functioning, sleep, and psychological well-being. However, school-based data on headache burden among Palestinian adolescents remain limited. This study aimed to assess the prevalence, clinical patterns, headache-related disability, and associated factors in Palestinian school-aged adolescents. <bold>Methods:</bold> A school-based cross-sectional study was conducted among Palestinian students aged 15–19 years in the West Bank. Data were collected using a structured, self-administered questionnaire. Headache diagnoses were classified using symptom-based criteria from the International Classification of Headache Disorders, 3rd edition. Headache-related disability was assessed with the Pediatric Migraine Disability Assessment Scale PedMIDAS. Psychological symptoms, sleep disturbance, and perceived stress were evaluated using standardized screening scales. Descriptive analyses and multivariable regression models were performed. <bold>Results:</bold> Among 535 students, most students reported non-specific headache 220 (41.2%), followed by tension-type headache TTH 124 (23.2%), migraine without aura 64 (12.0%), migraine with aura 35 (6.5%), and cluster headache 4 (0.7%), only 87 students (16.3%) reported no headache. According to PedMIDAS, 62 (11.6%) had severe disabilities. Severe depression was associated with migraine without aura (OR= 7.9, 95%CI: 1.8 to 35.6, <italic>P</italic> = 0.007), non-specific headache (OR= 4.0, 95%CI: 1.2 to 13.5, <italic>P</italic> = 0.0248), TTH (OR= 11.3, 95%CI: 3.1 to 40.7, <italic>p</italic> = 0.0002). Severe anxiety was associated with migraine with aura (OR= 14.8, 95%CI: 1.6 to 136.2, <italic>P</italic> = 0.017). Those reporting more than 5 headache days per month had markedly higher odds of greater disability (OR= 15.2, 95%CI: 7.1 to 33.9, <italic>P</italic> < 0.001). <bold>Conclusion:</bold> Headache disorders were highly prevalent among Palestinian adolescents and were associated with meaningful functional, psychological, and educational burden. Headache frequency and severe depression were key correlates of headache-related disability. These findings support the need for integrated school-based strategies addressing headache recognition, mental health, and timely medical care. </p>