Chronic daily headaches in children |
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Authors: | Andrew D Hershey MD PhD Marielle A Kabbouche MD Scott W Powers PhD |
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Institution: | (1) Headache Center, Division of Neurology, Cincinnati Children’s Hospital, 3333 Burnet Avenue, MLC 2015, 45229 Cincinnati, OH, USA |
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Abstract: | Chronic daily headache (CDH) is increasingly recognized as a problem in pediatrics and tertiary pediatric headache care. It
is estimated that up to 4% of the adult population has CDH. Many of these are chronic migraine (CM). The fraction of the pediatric
population with CDH appears to be lower, although the prevalence has not been adequately determined. The simplest definition
of CDH is more than 15 headache days per month. In the International Classification of Headache Disorders, Second Edition
(ICHD-II), several types of CDH have been identified. These criteria have been contrasted with the Silberstein-Lipton criteria,
with revisions suggested. The diagnosis of CDH is further complicated and may be initiated by the overuse of analgesic medications
(medication overuse headache) and requires the resolution of this issue before a final diagnosis can be established. In children,
most CDH appears to have migraine features, although it may not completely meet the ICHD-II criteria for migraine or CM. Evaluation
of CDH needs to include a complete history and physical examination to identify any possibility of the secondary headaches
or headaches directly attributed to a secondary cause. Treatment and management involve a multidisciplinary approach, including
acute therapy for when the headache severity increases (while avoiding medication overuse), preventative therapy to reduce
the frequency and impact of the CDH, and biobehavioral therapy to assist with long-term outcome. |
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