Chronic Daily Headaches in Children and Adolescents

Headaches, which are common in children and adolescents, represent a significant portion of patient complaints in a child neurology practice. Patients with episodic headaches, such as migraines with interval-free periods, and patients with chronic daily headaches with very few headache-free days, are often evaluated and treated differently from each other. The evolution of the classification of chronic daily headache has aided epidemiologic efforts. The disorder can be primary or related to other neurologic or systemic conditions. Comorbid conditions should be identified, and the contributing variables in the child's social, emotional, medical, and educational arenas should be assessed. The level of disability in terms of school attendance and function can help clinicians determine to what extent and how aggressively to treat these children. Rescue medications, such as barbiturates and narcotics, which can cause worsening of headaches, should be avoided.