Background and Objective <p>Globally, primary headache disorders, including migraine, tension type headache and cluster headache, are a leading cause of disability in children and adolescents. However, there has been a paucity of large-scale population-based studies to inform clinical decision making for paediatric patients. Consequently, we undertook a nationwide study to ascertain the current status of primary headache treatment in children and adolescents in China.</p> Methods <p>The study was based on the Hospital Prescription Analysis Cooperative Project of China, in which prescription data were extracted from a database of adolescent and child patients with a primary headache disorder from 160 hospitals in nine major Chinese cities from 2019 to 2023. In this study, we first analysed the trends in children and adolescents with primary headache in China over the past 5&#xa0;years, stratified by age and sex, and analysed the trends in prescribing patterns. We then explored the differences in prescribing patterns among different populations and patients with different types of diagnoses, with the aim of analysing the current status of treatment for children and adolescents with primary headache in Chinese healthcare institutions in a multi-dimensional approach.</p> Results <p>A total of 1735 outpatients were included. The majority of patients were 15–17 years of age (65.0% in 2023). Migraine (66.1%) and tension-type headache (33.5%) were the predominant headache types. Calcium channel blockers, vitamins, antidepressants, analgesics and anticonvulsants were the most commonly prescribed classes of drugs. Flunarizine was the most widely prescribed drug, with a 5-year average proportion of 23.6%. The majority of drugs prescribed to children were vitamins (30.9%) and calcium channel blockers (28.7%). Differences in prescribing between patients with migraine and patients with tension-type headache were evident, with patients with migraine using predominantly calcium channel blockers (35.9%) and analgesics (20.8%), whereas patients with tension-type headache had a predominance of antidepressants (28.9%) and muscle relaxants (19.2%).</p> Conclusions <p>The prevalence of primary headaches progressively increased with age in children and adolescents. Migraine and tension-type headache were the predominant headache diagnoses at this stage. Flunarizine was the most prescribed drug for both children and adolescents, typically indicated for the preventive treatment of migraine, whereas antidepressants were the most commonly prescribed drug for the preventive treatment of tension-type headache. The majority of treatments were aligned with the available evidence and guideline recommendations. Nevertheless, there is still a paucity of evidence regarding the use of some drugs; these require further attention and clarification.</p>