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Headache: Migraine and Chronic Headache - Description

Page Contents

Other Names

migraine headache, transformed migraine, chronic headache, chronic daily headache

ICD-9

346, headache, migraine

This code requires a fourth digit for the type of migraine.

Description

Headaches are common in children and adolescents and are generally infrequent, self-limited, and have little impact on the child. This module addresses headaches that recur frequently, last longer, are more severe, and impact the child’s activities and behavior. Such headaches are often labeled with terms like ‘migraine headache’, chronic headache, or ‘chronic daily headache.’ Headaches are rarely due to brain tumors or other serious disease, though concern about such causes and the difficultly of identifying a specific cause results in considerable angst on the part of parents and clinicians. Although some experts believe that migraines are a specific type of headache, others believe that tension and migraine headaches represent a spectrum of pain caused by similar mechanisms. Features of migraines in children include:
  • usually bilateral in children, although often unilateral in adolescents and adults,
  • may have preceding aura (~33% in children and adolescents)
  • may be accompanied by nausea and vomiting
  • may feel throbbing
  • may be accompanied by sensitivity to light and sound
  • may be helped by sleep
In this module, two kinds of headaches will be discussed, migraine headaches and chronic daily headaches. Although both are recurrent and chronic, the term "chronic daily headache" refers to a specific headache syndrome where headaches are present for 15 or more days/month for 3 or more months. [Hershey: 2006] Migraine or tension-type headaches may "transform" into chronic daily headaches. Though the reasons for such transformation and the mechanisms are unknown, some experts believe that effective treatment of less frequent headaches can prevent it. [Jensen: 2010] [Winner: 2008] Chronic daily headaches are thought to involve
  • a trigger, such as a viral infection or a mild head injury
  • genetic predisposition
  • medical, emotional, and/or psychological factors such as lack of sleep, stress, etc.
The trigger initially causes headaches that then become more frequent, eventually occurring almost every day and difficult to treat. Strategies for treatment and preventing progression include appropriate pain control with medications, avoiding overuse of ibuprofen and acetaminophen, reducing the frequency of headaches with behavioral techniques and preventive medications, and encouraging the adoption of a healthy lifestyle.
Although chronic headaches are infrequently due to underlying disease, benign intracranial hypertension (BIH) must be considered in the differential. In this condition, elevated cerebrospinal fluid pressure causes headaches and, if not checked, can lead to visual loss. BIH is more common in obese adolescent girls, particularly if they are on hormonal therapy or certain antibiotics (e.g. minocycline). If suspected, an ophthalmologic exam and an LP to measure CSF pressure are performed.

Genetics

Although environmental factors are important triggers, genetic predisposition is a likely contributor to migraine and chronic daily headaches. First degree relatives of individuals with migraine are at increased risk for developing migraine and data from twin studies also supports a genetic predisposition. [Russell: 2007]

Prognosis

Migraine is a chronic condition with a waxing and waning course. Treatment can decrease the frequency of migraine headaches over time, although many individuals will have migraines throughout their life. Treatment when headaches are infrequent may reduce the risk of progression to chronic daily headaches. [Jensen: 2010] [Winner: 2008]

Prevalence

Migraine headaches occur in at least 5 -10% of children between 5 and 15 years of age and in up to 10-23% of adolescents. [Lewis: 2004] In childhood, headaches affect girls and boys about equally but in adolescence girls have more headaches than boys. [Hershey: 2005] [Bigal: 2007] [Abu-Arafeh: 2010] [Victor: 2010] Chronic daily headaches are thought to occur in 1-2% of children and adolescents.[Mack: 2008]

Impact

Headaches, whether migraine or chronic daily headaches, can have a substantial impact on the life of a child or adolescent. Chronic daily headaches cause many lost days of school and work. Individuals with infrequent headaches may miss few days of school or work but can have decreased performance during headache episodes. Individuals with chronic daily headaches, although they are a small proportion of individuals with headaches, account for most of the doctor/emergency department visits and prescription drug use associated with headache.[Archibald: 1999]

Pearls And Alerts

On Initial Diagnosis Page

Headache Food Triggers

Motion sickness

Migraines in children are different than those in adults

Signs and symptoms that may signal intracranial pathology

Other migraine-like syndromes

Children with concussions

On Ongoing Assessment Page

Sleep disorders

On Treatment And Management Page

Aspirin should be avoided in children

Helpful Articles

PubMed search for migraines in children; reviews over the last 5 years

Hershey AD.
What is the impact, prevalence, disability, and quality of life of pediatric headache?.
Curr Pain Headache Rep. 2005;9(5):341-4. PubMed abstract

Diamond S, Bigal ME, Silberstein S, Loder E, Reed M, Lipton RB.
Patterns of diagnosis and acute and preventive treatment for migraine in the United States: results from the American Migraine Prevalence and Prevention study.
Headache. 2007;47(3):355-63. PubMed abstract

Headache: Migraine and Chronic Headache Module Authors

Lead Author: Lynne M Kerr MD, PhD, 6/2011
Authors: Francis Filloux M.D., 6/2011
Denise Nielsen MD, 6/2011
Reviewing Author: James Bale MD, 8/2011

The authors listed above are responsible for the overall Headache: Migraine and Chronic Headache Module. Authors contributing to individual pages in the module are listed on those pages.

Page Bibliography

Abu-Arafeh I, Razak S, Sivaraman B, Graham C.
Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies.
Dev Med Child Neurol. 2010;52(12):1088-97. PubMed abstract

Archibald N, Lipscomb J, McCrory DC.
Resource utilization and costs of care for treatment of chronic headache.
Agency for Healthcare Policy and Research AHRQ Technical Reviews. 1999;. PubMed abstract

Bigal ME, Lipton RB, Winner P, Reed ML, Diamond S, Stewart WF.
Migraine in adolescents: association with socioeconomic status and family history.
Neurology. 2007;69(1):16-25. PubMed abstract

Hershey AD.
What is the impact, prevalence, disability, and quality of life of pediatric headache?.
Curr Pain Headache Rep. 2005;9(5):341-4. PubMed abstract

Hershey AD, Kabbouche MA, Powers SW.
Chronic daily headaches in children.
Curr Pain Headache Rep. 2006;10(5):370-6. PubMed abstract

Jensen R, Zeeberg P, Dehlendorff C, Olesen J.
Predictors of outcome of the treatment programme in a multidisciplinary headache centre.
Cephalalgia. 2010;30(10):1214-24. PubMed abstract

Lewis, D, Ashwal, S, Hershey, A, Hirtz, D, Yonker, M, Silberstein, S.
Practice parameter: Pharmacological treatment of migraine headache in children and adolescents.
Neurology. 2004;63:2215-2224.

Mack KJ, Gladstein J.
Management of chronic daily headache in children and adolescents.
Paediatr Drugs. 2008;10(1):23-9. PubMed abstract

Russell MB.
Genetics in primary headaches.
J Headache Pain. 2007;8(3):190-5. PubMed abstract / Full Text

Victor TW, Hu X, Campbell JC, Buse DC, Lipton RB.
Migraine prevalence by age and sex in the United States: a life-span study.
Cephalalgia. 2010;30(9):1065-72. PubMed abstract

Winner, P.
Pediatric headache.
Curr Opin Neurol. 2008;21:316-322.