IntroductionRecurrent headache is a common symptom in children. By the age of seven, about 30%-50% of children have experienced headache [1][2][3][4]. These proportions dramatically increase during adolescence and may reach the 90% of the adolescent population [1,5,6]. About 15% of school age children suffer from recurrent headache, either tension-type headache or migraine, once a week or more [7][8][9].The frequency, intensity and quality of headaches have been associated with complex interactions between biological, psychological and socio/environmental factors [10][11][12][13]. Psychosocial mechanisms may be relevant in the etiology and pathogenesis of primary headaches and include social and economic status, resilience, housing conditions, family conditions, life events, school conditions and performance, leisure time activities, quality of life, situational factors, coping responses, psychiatric and somatic comorbidity, and behavioral problems [14]. A controlled study [14] of children and adolescents with primary headache showed that migraine is not related to family and housing conditions, school situation or peer relations, whereas tension-type headache is associated with a higher rate of divorced parents and fewer peer relations.There is substantial agreement on the role of the family in the development, maintenance and/or worsening of recurrent headache in adults [15][16][17]. The family not only has a crucial effect in the development of psychosomatic illnesses [18][19][20][21] but also is the basic unit for the health care of its members [22]. Given the broad consensus among researchers and clinicians in the field on the relevance of the family, it is surprising that few studies investigated the role of family factors on children affected by primary headaches. Ursula Napoli Vanna Axia Pier Antonio BattistellaAbstract The focus of this paper is the family factors associated with primary headache in children between 8 and 14 years. We studied the differences in the family ecology between 32 children with headaches and 32 healthy controls. The families were comparable for socio-economic status and children's age. We examined various aspects of the family connectedness, daily workload, social network and support, ecological fit and resilience using an Italian version of the Ecocultural Family Interview. Families of juvenile headache patients have less resilience in using their subsistence base, less social support and are less closely knitted than the control families. No difference was found for the amount of domestic workload. These findings suggest that psychosocial environment and family ecology are relevant to children's headaches, and that clinical support can be planned to sustain parents of children affected by primary headache.