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