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Chronic daily headache in children and adolescents: a clinic based study from India
1Department of Neurology, Vivekananda Institute of Medical Sciences, 59 Beadon Street, Calcutta-700006, India. saschakra@yahoo.com
Insights
Chronic Daily Headache (CDH) in Indian children presents uniquely, often lacking a clear headache history evolution. Anxiety, particularly academic stress, is a common factor, suggesting a need for revised diagnostic criteria.
Area of Science:
- Neurology
- Pediatrics
- Headache Medicine
Background:
- Chronic Daily Headache (CDH) is less common in Indian children than adults.
- Existing diagnostic criteria for chronic primary headaches may not fully apply to pediatric populations.
Purpose of the Study:
- To evaluate the headache phenomenology of CDH in Indian children and adolescents.
- To assess the validity of International Headache Society (IHS) 2004 classification for chronic primary headache subtypes in this demographic.
Main Methods:
- Retrospective study of 22 Indian children (aged 8-15) diagnosed with primary CDH (headaches >15 days/month for >6 weeks).
- Analysis of headache characteristics, including onset, vascular components, and resemblance to specific headache types (NDPH, CTTH, Chronic Migraine).
- Assessment of associated factors like anxiety and medication overuse.
Main Results:
- Most children (15/22) had headaches resembling New Daily Persistent Headache (NDPH) but didn't meet full IHS 2004 criteria.
- All cases exhibited a significant vascular component; some resembled Chronic Tension-Type Headache (CTTH) or Chronic Migraine without a clear history of episodic forms.
- Anxiety, primarily academic stress, was prevalent (19/22); medication overuse was not implicated.
Conclusions:
- CDH in Indian children differs significantly from adult presentations, often showing overlapping migraine and tension-type features.
- Current diagnostic criteria and terminology for pediatric chronic primary headaches require modification.
- Further research is needed to establish appropriate diagnostic guidelines for this population.
Abstract:
Chronic Daily Headache (CDH) is uncommon in Indian children compared to their adult counterpart. This is a retrospective study looking at the headache phenomenology of CDH in Indian children and adolescents. The validity of the case definitions of subtypes of chronic primary headaches mentioned in the IHS 2004 classification have been evaluated. 22 children (age range 8-15 years; M : F-16 : 6) diagnosed as having primary CDH using a modified definition seen between 2002 and 2003 have been studied. CDH has been defined as daily or near daily headaches > 15d/month for > 6 weeks. The rationale for this modified definition has been discussed. Majority of children (15/22) had a more or loss specified time of onset of regular headache spells resembling New Daily Persistent Headache (NDPH) but did not fulfil totally the diagnostic criteria of NDPH as laid down by IHS 2004. In all cases headache phenomenology included a significant vascular component. Headache phenomenology closely resembled Chronic Tension Type Headache (CTTH) in 4 patients and Chronic Migraine in 3 patients. However, in no patient in these groups, a history of evolution from the episodic forms of the diseases could be elicited. Heightened level of anxiety mostly related to academic stress and achievement was noted in the majority (19/22). Only a minority of patients (3/22) had anxiety and depression related to interpersonal relationships in the family. Medication overuse was not implicated in any patient. CDH in children in India is very much different from CDH in adults with the vast majority of patients exhibiting overlapping features of migraine and tension-type headache. There is need for a modified diagnostic criteria and terminology for chronic primary headaches in children.
