Chronic Daily Headache in Children and Adolescents

Abstract

Chronic daily headache (CDH) may be primary or secondary. Secondary causes can be suspected through "red flags" in the history and examination. With a prevalence of at least 1% and several associations, primary CDH is a common, often complex, chronic pain syndrome in children and adolescents. The intricate associations between stressors, psychiatric disorders (especially anxiety and depression), and CDH can be explained by "the limbically augmented pain syndrome" proposed by Rome and Rome. Disorders of sleep and other pain syndromes also may co-occur. For these reasons, a multiaxial classification is ideal. Many with primary CDH have features of both chronic migraine and chronic tension-type headache, contributing to confusion in subtyping. Primary CDH is often transformed from a primary episodic headache type, stressors being most responsible. Genetic factors also may facilitate chronification. Management should be biopsychosocial, family-centered, and often multidisciplinary, drugs being only one component. Treatment is still based on consensus, not evidence. Girls, migraineurs, and those with psychiatric comorbidity, medication overuse, and CDH onset before the age of 13 years and lasting for 2 years or longer, are at high risk for persistence; hence, such patients should be followed up into adult life. A classification for CDH should be included in the third edition of the International Classification of Headache Disorders.

Randomized Controlled Trial of the Acceptability, Feasibility, and Preliminary Effects of a Cognitive Behavioral Skills Building Intervention in Adolescents With Chronic Daily Headaches: A Pilot Study

“…According to recent reports, approximately 3.5% of adolescents in the United States have chronic daily headaches (Seshia, 2012). Chronic daily headaches are defined as headaches occurring for 15 or more consecutive days per month for at least 3 or more consecutive months (Silberstein & Lipton, 1996).…”

“…Over the past decade, there has been extensive research examining prevalence and risk factors among adolescents with chronic daily headaches (Dooley, Gordon, & Wood, 2005; Mazzone, Vitiello, Incorpora, & Mazzone, 2006; Pakalnis, Butz, Splaingard, Kring, & Fong, 2007; Palermo, Putnam, Armstrong, & Daily, 2007; Scher, Midgett, & Lipton, 2008; Seshia, 2012, Wang, Juang, Fuh, & Lu, 2007a; Wang et al, 2007b). In addition, many studies have examined chronic or recurrent headaches in children and adolescents, using different criteria for chronic daily headaches than that described by Silberstein and Lipton (1996; 2001).…”

Headache, eating and sleeping behaviors and lifestyle factors in preadolescents and adolescents: preliminary results from an Italian population study

“…Epidemiological studies showed that 58.4 % of children and adolescents report headaches, with higher prevalence in females [1][2][3][4][5]. Migraine occurs in 5-11 % of the adolescent population and tension-type headache (TTH) in 5.1-18 % [1][2][3][4], while the prevalence of chronic daily headaches is estimated to be around 3 % [5].…”

Headache as an Emergency in Children and Adolescents

“…MRI provides superior visualization compared with CT, and a recent study showed that MRI at higher field strengths and with increased resolution, in combination with sequences such as diffusion-weighted and T2-susceptibilityweighted imaging (SWI), increases the number of small brain abnormalities detected (though these findings may be in most cases irrelevant) [32]. In a recent review [27] regarding the use of neuroimaging in pediatric headache patients, the authors conclude that in the event of an abnormal neurological examination or suspicious clinical history, imaging should be performed, preferably MRI. The MRI protocol should include MR angiography, T2-weighted gradient-echo and susceptibility-weighted sequences, diffusion-weighted sequences and post-gadolinium-enhanced sequences.…”