Background <p>Primary headache disorders are the most common neurological conditions affecting children and adolescents and among the leading causes of disability worldwide. However, population-level data on prevalence, medication use, and health care utilization remain limited. This study assessed the prevalence of recurrent primary headache, migraine, and tension type headache, and examined associated patterns of medication use and health care utilization.</p> Methods <p>A cross-sectional survey was conducted among students in grades 6–12 across 11 schools in Central Florida, USA. Self-administered questionnaires captured headache characteristics and relevant clinical, psychological, and behavioral factors. Migraine and tension type headache were classified according to self-reported International Classification of Headache Disorders, 3rd Edition diagnostic criteria. Descriptive statistics and regression models examined demographic associations with headache type and prediction models of medication use and health care utilization.</p> Results <p>The sample included <i>N</i> = 583 students (<i>M</i>_age<i>=</i>13.58, <i>SD =</i> 2.25), of whom 53% were female. Overall, 67% reported experiencing at least one headache in the past three months. In the total sample, 30% of students reported at least weekly recurrent primary headache, 18.2% fulfilled criteria for migraine and 24.9% for tension type headache. Female students had higher odds of experiencing recurrent primary headache than male students (OR = 2.80, 95% CI [1.90, 4.12]), while age was not a significant predictor. Among students experiencing recurrent primary headache, 73.7% reported using medication, and 24.6% had sought medical attention for headaches in the past three months. Over-the-counter medication use was predicted by higher headache frequency, passive pain coping, and social support seeking. Prescription medication use was predicted by sex, language, headache intensity and frequency, stress and passive pain coping strategies. No demographic, psychological or clinical variables significantly predicted headache-related health care utilization in this sample.</p> Conclusions <p>Primary headaches and associated medication use are highly prevalent in youth. These findings highlight the need for improved monitoring and targeted intervention strategies to reduce the prevalence and burden of pediatric primary headache disorders. Increased attention to medication patterns and health care utilization may inform and facilitate action in health policy responses.</p>