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[The treatment of children with non-migrainous headaches]
1Departamento de Pediatría, Regional Academic Health Center, University of Texas Health Science Center San Antonio, McAllen, TX 78503, USA. leogarcia@pol.net
Insights
This review covers non-migrainous headaches (NMH) in children, detailing pain mechanisms and treatments. Effective management of pediatric headaches is achievable through clinical evaluation and tailored therapies.
Area of Science:
- Pediatric Neurology
- Pain Mechanisms
- Headache Syndromes
Context:
- Headaches are a frequent complaint in pediatric outpatient settings, with 22% of new patients presenting with headache.
- Understanding the underlying pain mechanisms (vasodilation, inflammation, muscular tension, neurogenic factors) is crucial for diagnosis.
- Clinical evaluation and patient history are primary diagnostic tools, often negating the need for routine diagnostic studies in children with normal examinations.
Purpose:
- To review non-migrainous headaches (NMH) in pediatric patients.
- To elucidate the various pain mechanisms associated with different headache types.
- To discuss current treatment strategies, emphasizing clinical experience and a proposed dietary approach with caffeine.
Summary:
- Headaches in children encompass acute, chronic, generalized, and localized presentations, with recurring headaches being common.
- Vascular mechanisms are frequently implicated in pediatric headaches.
- The study advocates for dietetic interventions combined with caffeine for certain headache types.
Impact:
- Provides a clinical framework for diagnosing and managing non-migrainous headaches in children.
- Highlights the efficacy of clinical assessment over routine investigations for common pediatric headaches.
- Suggests satisfactory treatment outcomes for pediatric NMH, improving patient and parental quality of life.
Aims:
The purpose of our study is to review non-migrainous headaches (NMH), the pain mechanisms and their treatment, with emphasis on the author's clinical experience.
Development:
Headaches are commonplace in the daily practice of Paediatrics. About 22% of new patients who came to the Neuropaediatric department as outpatients presented headaches as the reason for their visit. Whenever there is a headache, there must be some pain mechanism involved. These mechanisms are vasodilatation, inflammation, traction and displacement of intracranial structures, sustained muscular tension, or some neurogenic mechanism. Clinical evaluation enables us to diagnose the type of headache and to treat it. Physical and neurological explorations are normal in most children with headache. The classification of syndromes includes acute generalized headache, acute localized headache, acute recurring headache, chronic progressive headache and chronic non-progressive (recurring) headache. Recurring headaches occur frequently in children and are more readily diagnosed from clinical data than by examinations. Routine use of any diagnostic study provides no indication of when the clinical history has no associated risk factors and the examination of the child is normal. Therapy is based on the type of headache. Most headaches in children are due to a vascular mechanism. The author advocates the use of a dietetic treatment in association with the intake of small amounts of caffeine BID.
Conclusions:
The treatment of NMH depends on the kind of syndrome presented but, for the most part, it is very satisfactory for both the patients and their parents.
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