Chronic and recurrent headache

Abstract 

This chapter considers a practical overview to the diagnosis and management of migraine and chronic headaches in childhood. They are very common, up to 10% in some series. History is very important, the nature of the pain,its radiation and initiating and exacerbating factors need to be assessed. There is probably a spectrum from classic migraine to tension headaches. Some migraine variants such as migraine accompagné, hemiparetic migraine and cluster headaches are discussed as well as overlaps with epilepsy. Some migraine-like symptoms may be symptomatic of metabolic disease. Most do not need further investigation, but in some it may be worthwhile imaging, performing an EEG or doing metabolic investigations. Morbidity in terms of time off school needs to be assessed with respect to management. Sympathetic reassurance, simple analgesia, attention to trigger factors and prophylaxis should be the sequence plan in most cases.

Keywords: chronic daily headache, migraine, tension headache, pain management, differential diagnosis, management

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• f1 Correspondence to: SHG. Tel: +44 (0)121 333 8704; Fax: +44 (0)121 333 8701; E-mail: s.h.green@bham.ac.uk