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Characterization of chronic daily headaches in children in a multidisciplinary headache center
A D Hershey1, S W Powers, A L Bentti
1Division of Neurology, Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
Insights
Chronic daily headaches (CDH) in children often present as migraines. This study identified three distinct groups based on headache frequency, aiding in better characterization and treatment of pediatric headaches.
Area of Science:
- Pediatric Neurology
- Headache Medicine
- Clinical Research
Background:
- Chronic daily headaches (CDH) affect over 4% of adults, but characterization in children is limited.
- Existing criteria for CDH are controversial, necessitating further research in pediatric populations.
- Understanding pediatric CDH is crucial due to its prevalence and potential impact on quality of life.
Purpose of the Study:
- To characterize headaches in children aged 3 to 18 years presenting with frequent headache patterns.
- To investigate the clinical features and diagnostic criteria of chronic daily headaches in a pediatric cohort.
- To identify distinct subgroups within pediatric CDH based on headache frequency and presentation.
Main Methods:
- Establishment of a dedicated Headache Center for pediatric evaluations.
- Retrospective analysis of 577 children over 34 months using a definition of >=15 headaches per month for CDH.
- Clinical assessment including headache characteristics, International Headache Society criteria, and symptom reporting (pain, nausea, photophobia, phonophobia).
Main Results:
- Out of 577 children, 200 (34.6%) met the criteria for CDH.
- The average age of first headache was 9.3 years, with presentation at 12.5 years.
- Ninety-two percent had clinically diagnosed migraines, and 60.5% met IHS migraine criteria. Common symptoms included pulsatile pain (79%), nausea (63.5%), and photophobia/phonophobia (59.5%).
- Three subgroups emerged: frequent non-daily headaches (37%), episodic daily headaches (43.5%), and continuous daily headaches (19.5%).
Conclusions:
- Pediatric CDH features closely resemble those of migraine headaches.
- Frequency-based categorization reveals three distinct pediatric CDH groups: frequent, intermittent daily, and continuous daily.
- The continuous daily headache group is unique, yet its underlying nature remains migrainous, suggesting targeted migraine therapies may be beneficial.
Background:
Chronic daily headaches (CDH) occur in >4% of the adult population. The criteria for CDH, however, are controversial. In children, the characterization of frequent headaches and CDH is limited.
Methods:
A Headache Center to characterize headaches in children (3 to 18 years old) was established. Over 34 months, 577 children have been evaluated. With use of a definition of > or =15 headaches per month, 200 (34.6%) children had CDH.
Results:
The average age at the first headache in these children was 9.3 +/- 3.6 years, whereas the average age at presentation to the Headache Center was 12.5 +/- 3.1 years. Sixty-eight percent were girls, 88% were Caucasian, and 11% were African American. Ninety-two percent clinically had migraine headaches, whereas 60.5% met the International Headache Society migraine criteria. The pain was pulsatile in 79%, 63.5% had nausea with or without vomiting, and 59.5% had photophobia and phonophobia. Three subcategories emerged, with 37% having frequent headaches but not daily, 43.5% having episodic daily headaches, and 19.5% having a continuous headache.
Conclusion:
The features of CDH in children most closely match those of migraine. A clear division of these children using frequency identifies three groups: frequent headaches (15 to 29), daily intermittent, and daily continuous. The daily continuous group is the most unique; however, the nature of these headaches continues to remain migrainous.