[Headache in children.]

Idiopathic headaches are probably the most common problem in schoolchildren. The prevalence increases up to 70% in 14-year-old adolescents, with migraines ranging from 10% to 20%. Tension headaches are often understandable on a psychosocial and behavioral basis; in migraine, however, a familial disposition of 60%-80% is well known. Migraine in childhood is initially more common in boys; after puberty girls predominate. At the beginning of migraine development the headache is often not hemisymptomatic in children. Attack duration is shorter than in adults and often lasts less than 4 h. Irreversible neurological deficits are extremely seldom and only occur as ophthalmoplegic attacks in infants. In general, diagnostic studies in headache patients can be restrcted to a neurological examination and electroencephalography. Acute treatment of migraine should include environmental isolation and analgesics such as acetylsalicylic acid or paracetamol; sometimes antiemetic drugs may be useful before. In refractory cases one should try ergotamine. Only a few controlled studies on the prophylaxis of migraine in children have been reported. The first substance introduced in the prophylactic regime was the beta-blocker propranolol. According to results in adults, further optimization could be expected by using thebeta (1)-specific agent metoprolol. New investigations have shown significant efficacy of the calcium antagonist flunarizine as well as low-dose acetylsalicylic acid. Dihydroergotamine drops, often used in pediatric practice, have not proved superior to placebo; the lack of side effects may, however, allow use of the substance as a first-line strategy in staged prophylaxis. In case of failure, nonpharmacological methods such as acupuncture may be tried, especially in older and cooperative children. Vasoconstriction training has been studied in some children; other biofeedback methods and behavioral strategies including relaxation and hypnosis have proved as effective. Follow-up of spontaneous migraine courses in children has shown, that 60% are still or again suffering from migraine as adults. It is presently unknown, whether pharmacological prophylaxis during several months followed by attack-free periods of months or years may influence the long-term prognosis. For tension headaches, transcutaneous electrical nerve stimulation (TENS) has produced good improvement in recent investigations in about 3/4 of cases; full remissions were possible in most cases. A combination of relaxation and behavioral therapy should be recommended where possible, especially in cases of therapeutic resistance.