Chronic daily headaches in pediatric neurology practice

Using a comprehensive computerized database for a single general pediatric neurology ambulatory practice, the clinical profile, together with the precipitating features and outcomes, in a consecutive series of children with chronic daily headache was ascertained. Chronic daily headache was defined as persistent or daily headaches of at least 3 months' duration. Children with persistent headaches owing to a serious medical condition were specifically excluded from analysis. Of 1669 children (24% of total seen) referred over an 11-year inclusive interval for the evaluation of headaches, 50 (3%) merited a diagnosis of chronic daily headache. The overwhelming majority were female (45/50; 90%), with a mean age at diagnosis of 12.9 years (range 7-16 years). Transformed migraine was determined to be the etiology in the majority (35/50; 70%), with a minority attributable either to postconcussion syndrome (7/50; 14%) or new daily persistent headaches (6/50; 12%). Analgesic abuse was evident in a majority (26/50; 52%). Treatment consisted predominantly of migraine and analgesic education, with a majority of children (42/50; 84%) also receiving daily prophylaxis. Four fifths (41/50; 82%) returned for at least one follow-up. Of these, 56% (23/41) were improved, 32% (13/41) unchanged, and 12% (5/41) worse. Eventually, almost half (20/41) experienced complete resolution of their headache symptoms, with a mean time to resolution of 8 months (range 2-48 months). Children with chronic daily headache are thus a small subset of children with headache seen in general ambulatory practice. They tend to be females in the midteen years experiencing a transformed migraine complicated by analgesic abuse, suggesting potential preventability. Simple measures, which can include the use of prophylactic agents, can be expected to result in improvement and eventual resolution of headache symptoms.