Comprehensive evaluation and treatment of recurrent pediatric headache

Continuity of care with a clinician who has established a therapeutic alliance is the most important aspect of recurrent pediatric headache management. The provider should assume a concerned and supportive manner that promotes self-esteem and self-mastery and control. Patient and family efforts to reduce functional disability and return to normal activities should be strongly reinforced. Treatment regimens should be reviewed for side effects, compliance, and perceived efficacy. Behavioral techniques should be reviewed in detail with opportunities for the clinician to "trouble shoot" any difficulties encountered by the patient. Periods of potentially increased stress (eg, transitions or loss) should be anticipated and managed prospectively. The clinician should periodically reassess possible psychosocial issues and make appropriate mental health referrals. In the long run, regular follow-up by the primary care clinician remains the most important factor in the successful management of recurrent pediatric headache.