[Chronic Headache in Children and Adolescents]

Area of Science:

• Neurology
• Pediatric Neurology
• Pain Medicine

Background:

• Primary headache disorders, including migraine and tension-type headache (TTH), frequently emerge in childhood and adolescence, with prevalence increasing during school years.
• TTH involves central pain sensitization and nociceptive neuron activation, while migraine is a primary brain disorder characterized by altered pain modulation and cortical processing.
• Bio-psycho-social factors significantly influence both primary headache types, though secondary headaches from brain alterations are rare.

Purpose of the Study:

• To outline the clinical presentation and diagnostic criteria for primary headache disorders in pediatric and adolescent populations.
• To describe the underlying pathophysiological mechanisms of tension-type headache and migraine.
• To present current treatment strategies and therapeutic goals for primary and secondary headaches.

Main Methods:

• Diagnosis is primarily based on detailed patient history and physical examination for typical recurrent headaches.
• Clinical criteria are used for diagnosis, with further investigations indicated in cases of suspected abnormalities.
• Treatment approaches are tailored to headache type: multimodal pain therapy for TTH, acute medication for migraine attacks, and addressing the underlying cause for secondary headaches.

Main Results:

• Prevalence of primary headaches rises during childhood and adolescence.
• Central pain mechanisms are key in TTH; migraine involves brain-based pain modulation and processing abnormalities.
• Effective treatment aims to reduce pain, enhance self-efficacy, improve physical function, and restore daily activities.

Conclusions:

• Primary headaches are prevalent in youth and require accurate diagnosis based on clinical evaluation.
• Understanding the distinct pathophysiological mechanisms of TTH and migraine guides targeted treatment.
• Comprehensive treatment strategies focusing on pain reduction, functional recovery, and psychosocial well-being are crucial for managing headache disorders.