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Chronic daily headache in children and adolescents
1Pain Innovations Inc., 38 Hampton Crescent, London, Ontario N6H 2N8, Canada. pamcgrat@uwo.ca
Insights
Chronic daily headache (CDH) in children and adolescents presents unique challenges due to unknown pathophysiology. Current treatments are based on adult studies and clinical experience, highlighting the need for child-specific research.
Area of Science:
- Pediatric Neurology
- Headache Medicine
- Clinical Research
Background:
- Chronic daily headache (CDH) is a complex condition in children and adolescents, often lacking organic pathology.
- Its presentation and potential etiologies differ between pediatric and adult populations.
- Understanding the pathophysiology of pediatric CDH is limited, relying heavily on adult study extrapolations.
Purpose of the Study:
- To review the current understanding of chronic daily headache in children and adolescents.
- To highlight the diagnostic and therapeutic challenges in this population.
- To emphasize the need for child-specific research and management strategies.
Main Methods:
- Literature review and synthesis of existing studies on pediatric and adult CDH.
- Analysis of presumed pathophysiological mechanisms.
- Evaluation of current diagnostic and treatment principles.
Main Results:
- Pediatric CDH exhibits distinct features from adult CDH, suggesting different underlying mechanisms.
- Presumed mechanisms include neurogenic inflammation, vascular reactivity, and serotonin pathways for migraine-like cases, and musculoskeletal factors for others.
- Accurate diagnosis relies on detailed history and pain assessment, but objective measures are lacking.
- Limited data exists on the efficacy of various therapies for pediatric CDH subtypes.
Conclusions:
- The pathophysiology of pediatric CDH remains largely uncharacterized, necessitating further investigation.
- Current management strategies are extrapolated and require validation through child-centered research.
- A comprehensive, child-focused approach is crucial for effective diagnosis and treatment of chronic daily headache in young individuals.
Abstract:
Chronic daily headache (CDH), an almost continual headache in the absence of organic pathology, is an exceptionally challenging type of headache to treat in children and adolescents. CDH has different expressions in children and adults; the different expressions may reflect several different etiologies or a developmental continuum. Although a positive family history predisposes children to develop headache, many environmental, biological, and psychological processes may share a role in the etiology. To date, no studies have examined the pathophysiology of CDH in children so that our understanding is presumed, rather than documented, and based primarily on extrapolation from adult studies. For some cases with migraine features, presumed mechanisms include a neurogenic inflammatory cascade, vascular reactivity, and serotonin, whereas for other cases, mechanisms may include pericranial muscle tenderness or musculoskeletal abnormalities, as noted recently for adults. A skilled and careful history is the first step to ensuring an accurate diagnosis for children with CDH. Pain assessment is an integral component of diagnosis and treatment. We need an objective measure of headache activity and an understanding of the factors that cause or exacerbate headaches for an individual child. Although many drug and nondrug therapies are available for treating children's headache, we lack data about which therapies are best for children with CDH or its subtypes. The current principles guiding our management of CDH in children and adolescents are extrapolated from the existing literature on childhood headache, CDH in adults, and our clinical experience. A child-centered focus is particularly important in the treatment of CDH because it is not caused by an underlying disease or disorder.