Daily Headache In Children Research Articles

Chronic daily headache in children and adolescents.

Characterize chronic daily headache in those less than 20 years of age. Prospective, observational, and sequential. Private practice Pediatric Neurology Clinic in a Canadian city (Winnipeg). Patients and data collection: Data on those referred with headache between September 1998 and December 2001 were entered on data sheets. Patients were followed up for one month to four years. One hundred and forty-three (31%) of 463 referred with headache had chronic daily headache with duration of one month to five years (median: eight months). The age range was 5.5 years to 20 years (median: 13 years). There were significantly more females (N=93) than males (N=50). The main groups were: (1) transformed migraine: 6 (4%), (2) transformed tension-type headache: 80 (56%) and (3) transformed comorbid migraine and tension-type headache: 39 (27%). Tension-type features dominated in 94%. Analgesia overuse occurred in two. Stressors were recognized in 60 (42%); anxiety disorder was diagnosed in 8 (6%), and depression in 13 (9%). Computed tomography scans were done in 31 (22%), and MRI/MR angiography in 8 (6%) and were normal or showed nonspecific incidental findings. Twenty-two (15%) were lost to follow-up; 115 of the remaining 121 (95%) were headache free or greatly improved, 63 (55%) without specific treatment. Chronic daily headache is a common headache disorder in children and adolescents, especially in teenage girls. A prospective neuropsychiatric approach is necessary for evidenced-based management, since the condition has mental health, social and economic ramifications.

113 Chronic Daily Headache in Children and Adolescents

113 Chronic Daily Headache in Children and Adolescents

Chronic daily headaches in children

Chronic daily headache (CDH) or highly frequent headaches are being recognised as an increasing problem. In adults it is estimated that up to 4% of the population has CDH, however, this number appears to be lower in children. The actual prevalence of CDH in children, however, has not been determined. The simplest definition of CDH is > 15 headache days per month. In the international headache society (IHS) criteria, only chronic tension-type headaches and chronic cluster headaches are recognised as CDH. Criteria for CDH have been suggested for adults that mirror the IHS criteria. In children, the majority of CDH appear to be migraine related. The next revision of the IHS criteria has been proposed to include chronic migraine as one of the CDH. Evaluation of CDH needs to include a complete history and physical examination to identify any possibility of the headache representing secondary headaches. Treatment and management involves a multi-tiered approach, which includes abortive therapy when the headache becomes more severe. With the precaution of avoiding overuse of analgesic medication, prophylactic therapy is used to help reduce the characteristics of the headache as well as the frequency and mild behavioural therapy.

Chronic daily headache in children and adolescents.

Chronic daily headache (CDH), an almost continual headache in the absence of organic pathology, is an exceptionally challenging type of headache to treat in children and adolescents. CDH has different expressions in children and adults; the different expressions may reflect several different etiologies or a developmental continuum. Although a positive family history predisposes children to develop headache, many environmental, biological, and psychological processes may share a role in the etiology. To date, no studies have examined the pathophysiology of CDH in children so that our understanding is presumed, rather than documented, and based primarily on extrapolation from adult studies. For some cases with migraine features, presumed mechanisms include a neurogenic inflammatory cascade, vascular reactivity, and serotonin, whereas for other cases, mechanisms may include pericranial muscle tenderness or musculoskeletal abnormalities, as noted recently for adults. A skilled and careful history is the first step to ensuring an accurate diagnosis for children with CDH. Pain assessment is an integral component of diagnosis and treatment. We need an objective measure of headache activity and an understanding of the factors that cause or exacerbate headaches for an individual child. Although many drug and nondrug therapies are available for treating children's headache, we lack data about which therapies are best for children with CDH or its subtypes. The current principles guiding our management of CDH in children and adolescents are extrapolated from the existing literature on childhood headache, CDH in adults, and our clinical experience. A child-centered focus is particularly important in the treatment of CDH because it is not caused by an underlying disease or disorder.

Chronic Tension-Type Headache in Children and Adolescents

In this study, the causes, predisposing factors and clinical features of chronic daily headache in children and adolescents were studied within the population of patients attending a specialist headache. The International Headache Society's (IHS) criteria for the diagnosis of chronic tension type headache (CTTH) were assessed for their applicability in the paediatric age group. Over a period of three years, demographic and clinical data were collected prospectively on all children who attended the clinic and suffered from daily attacks of headache. One hundred and fifteen children and adolescents (32% of all clinic population) had chronic daily headache, of whom 93 patients (81%) fulfilled the IHS criteria for the diagnosis of CTTH. They were between 3-15 years of age (mean: 11.1, SD: 2.3) and their female to male ratio was 1.2 : 1. Around one third of the patients also suffered from migraine (mainly migraine without aura). The headache was described as mild in 60.9%, moderate 36.5% and severe 2.6%. Headache was located at the forehead in 53% or over the whole of the head in 29.6%. Pain was described as 'just sore' or dull by 73.9%. During attacks of headache, at least half the patients reported light intolerance, noise intolerance, anorexia or nausea. Thirty-two percent of patients had at least one underlying chronic disease that may have contributed to the pathogenesis of the CTTH. Eleven percent had serious stressful events related to family illnesses and in four patients headaches were triggered by family bereavement. Fourteen percent were investigated with neuroimaging and 22% were referred for clinical psychology assessment and management. In conclusion, CTTH is a common cause of headache in children attending a specialist headache clinic. The clinical features closely match those of adult population and the IHS criteria for the diagnosis of CTTH can be adapted for use in children. Predisposing stressful risk factors, physical or emotional, are present in a large proportion.

Characterization of chronic daily headaches in children in a multidisciplinary headache center.

Chronic daily headaches (CDH) occur in >4% of the adult population. The criteria for CDH, however, are controversial. In children, the characterization of frequent headaches and CDH is limited. A Headache Center to characterize headaches in children (3 to 18 years old) was established. Over 34 months, 577 children have been evaluated. With use of a definition of > or =15 headaches per month, 200 (34.6%) children had CDH. The average age at the first headache in these children was 9.3 +/- 3.6 years, whereas the average age at presentation to the Headache Center was 12.5 +/- 3.1 years. Sixty-eight percent were girls, 88% were Caucasian, and 11% were African American. Ninety-two percent clinically had migraine headaches, whereas 60.5% met the International Headache Society migraine criteria. The pain was pulsatile in 79%, 63.5% had nausea with or without vomiting, and 59.5% had photophobia and phonophobia. Three subcategories emerged, with 37% having frequent headaches but not daily, 43.5% having episodic daily headaches, and 19.5% having a continuous headache. The features of CDH in children most closely match those of migraine. A clear division of these children using frequency identifies three groups: frequent headaches (15 to 29), daily intermittent, and daily continuous. The daily continuous group is the most unique; however, the nature of these headaches continues to remain migrainous.

Chronic daily headache in children and adolescents: current status and recommendations for the future. Pediatric Committee of the American Association for the Study of Headache.

The Pediatric Committee of the American Association for the Study of Headache was created in 1994 to develop a plan for comprehensively addressing global issues of headache in childhood. It was the impression of clinicians and researchers with an interest in childhood headaches that a clearer focus was needed to facilitate progress in the study and management of pediatric headache. It was further felt that approaches to treatment and outcomes, as well as assessment and classification schema for pediatric patients needed to be examined separately. The goal of the committee is to integrate anecdotal, clinical, and research expertise into a plan for addressing headaches in the pediatric population in the future. During the last 5 years, substantial attention has been devoted to chronic daily headache, primarily in adult populations. It is the purpose of this paper to review the literature of chronic daily headache in children, and propose areas for further exploration, given the recent emergence of interest in this diagnostic entity.

Chronic Daily Headache in Children and Adolescents: A 2‐Year Prospective Study

Chronic daily headache in children and adolescents has not been well described. We analyzed data for 37 children and adolescents who presented with chronic daily headache to our Pediatric Headache Clinic over a 2-year period. These youngsters had five distinct headache patterns; 40% of them had the "comorbid" pattern, 35% were classified with new daily persistent headache, 15% with transformed migraine, 5% with chronic tension-type headache, and 5% could not be classified. There were no significant differences by diagnosis in externalizing and internalizing behaviors, type A behaviors, disability, pain severity, days missed from school, and number of coping skills employed. Children and adolescents with chronic daily headache have distinct clinical patterns, but for the most part, have similar disability. Differences between adult and childhood chronic daily headache are emphasized.

Chronic Daily Headache in Children and Adolescents

Chronic Daily Headache in Children and Adolescents

Chronic Daily Headache in Children and Adolescents

Recurrent headache is a relatively frequent problem in children and adolescents, with the majority of the research attention focused on pediatric migraine. This study assessed differences in consequences to headaches, coping with headaches, and associated disability in children and adolescents attending a headache clinic who were diagnosed with migraine, chronic daily headache, or carried both diagnoses. Results, generally indicated higher levels of impairment for patient's with chronic daily headaches. These patients were also more likely to use blaming others and wishful thinking as coping mechanisms. Gender and racial status interacted with headache diagnosis to predict parent response patterns and disability outcomes. The results provide initial support for the applicability of Martin's functional model of chronic headaches to a pediatric population.