Pediatric Headaches With The Challenges of The New Normal

Chronic headaches in children and adolescents: Dilemma in diagnosis and management
Shahnaz Ibrahim

Chronic primary headaches (CPH) are a disabling disorder for children, and adolescents, with a reported prevalence of 0.78% in adolescents, while the prevalence rises up to 1.75% when including the Medication overuse headache (MOH). In adolescents and children suffering from this condition, attacks may interfere with the predictability of normal life activities and affect the ability to work, perform routine course and school activities, and maintain functional social relations. CPH determines a huge decrease of the quality of life chronic migraine (CM), chronic tension-type headache (CTTH) and new daily persistent headache (NDPH) are classified as CPH in the International Classification of Headache Disorders 3rd edition (ICHD 3). Medication-overuse headache (MOH) is classified among secondary headaches, but it generally affects patients with a pre-existing primary headache. It is important for parents and health personnel to work together and develop an individualized treatment plan, depending on the age, social history, patterns of headache, medication use and especially focusing on lifestyle pattern, including type of food, sleep habits and use of mobile phones.

Pediatric Headaches other than Migraine
Farida Jan

Headaches can broadly be divided in children into primary and secondary headaches. The types of primary headaches found in children are almost the same as those found in adults. Most common primary headaches are migraine headaches, tension type headaches and cluster headaches. Tension type headaches (TTHs) are the most common headache type in children with some studies reporting a prevalence more than 45%; The ICHD-3 beta sub classifies TTHs as infrequent less than 12/year; frequent 1-15/month; and chronic more than 15 /month. The classification and semiology is opposite to migraine but in children it is difficult to classify. Secondary headaches need to be ruled out. Management of TTHs need acute or abortive therapy; preventive therapy when frequent and requires life style modification. Medications similar to migraine management are used along with behavioral interventions, coping skills and stress management. Cluster headaches, much less common than migraine and TTHs, occurs in a specific location in a series lasting weeks or months which might recur yearly. Other associated symptoms are there as well which can be labelled as autonomic dysfunction. More common after 10 years of age, exact cause unknown but dehydration, cigarette smoke, allergies, smog and loud noises can be contributing factors. Oxygen therapy can help if started with the start of episode, besides medicines used in other type of headaches and steroids.