kids’ korner
By A. David Rothner, MD
When Headaches Don’ t Go Away
Children and teens can follow these tips to manage chronic daily headaches.
H
EADACHE IS COMMON AMONG THE PEDIAT- RIC POPULATION— so common that it affects up to 51 percent of children during their elementary school years. 1 The more frequent or serious headaches only affect 17 percent of children, but these can impede a child’ s daily activities and a family’ s function. Among the more severe headache types is chronic daily headache( CDH), which affects 2 percent of children.
CDH is a daily or near-daily headache in which the headache is present for three months or longer, occurs at least 15 days a month, and lasts at least four hours per day. The more severe form occurs 24 hours a day, every day of the month. Girls tend to experience chronic headache more than boys, and it seems to increase with age. 2
While it would be simpler to put a singular face on the condition, CDH comes in many forms. Holistic treatment that involves both traditional medications as well as lifestyle and dietary changes is necessary to keep a child in school and away from over-the-counter medications that can exacerbate the situation.
CHARACTERISTICS OF CHRONIC DAILY HEADACHE
CDH occurs in primarily four varieties:
• CDH can be a tension-type headache that’ s evolved into a daily or near-daily problem, where migraine is not present.
• CDH can start as migraine and evolve into daily or near-daily tension-type headache accompanied by a few migraines a month. This is sometimes called CDH with episodic superimposed migraine, transformed migraine or mixed headache.
• One form of CDH is New Daily Persistent Headache, in which an infection or other trigger causes a child to awaken with their first headache one day and continue to experience that headache from that day forward.
• Post-concussion headache can turn into a chronic issue among children who had few or no headaches prior to the concussion. For some children, CDH can be traced to an event such as a concussion or an infection. However, for most children, the reason for the new onset or long-time occurrence is still unknown. 2
We do know that stress, inadequate sleep or diet, and medication overuse can play a role in exacerbating a headache condition. When a child with CDH misses an excessive amount of school( some have missed years of school) or overuses over-the-counter medications, this complicates the condition and diminishes the quality of life for both the children and their families. For one, overuse of over-the-counter medications can exacerbate a headache condition, turning a headache condition that might otherwise have been treatable into a chronic condition. With
1. Lopez et al.“ Pediatric Headache.” Medscape Reference. May 14, 2012. 2. Gladstein et al.“ Chronic Daily Headache in Children and Adolescents.” Seminars in Pediatric Neurology. 2010; 17( 2): 88-92.
16 HEAD WISE | Volume 2, Issue 4 • 2012