Adolescents get as well as they give

Abstract

Primary chronic daily headaches (CDH) in adults have emerged as a public health priority in recent years because of their prevalence and substantial disability. Although numerous clinic-based studies are available, recent population studies have done much to define the natural history and risk factors for CDH in adults. The current issue of Neurology extends population-based work on CDH to adolescents with two important new studies.1,2 In the simplest terms, CDH is defined by the occurrence of 15 or more headache days per month. Defined in this way, CDH affects 4% of American adults3–5 and makes up a majority of patients seen in tertiary headache clinics.6–8 In children and adolescents, however, the prevalence of CDH appears to be lower.9,10 The most disabling form of CDH evolves from migraine and has been called transformed migraine (TM) or chronic migraine (CM). TM is defined by Silberstein-Lipton (S-L) criteria11 as a primary CDH disorder, linked to migraine by a current or prior history of migraine; this definition does not require a specific number of migraine attacks. In contrast, CM defined by the International Classification of Headache Disorders-2 (ICHD-2) requires 15 or more days per month of migraine without aura. Several additional types of CDH are also recognized. These include chronic tension-type headache (CTTH), new daily persistent headache (NDPH), and hemicrania continua (HC). Each of these is defined based …