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Managing Headache in Young People

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Handbook of Headache

Abstract

Headache is a frequent complaint in childhood and adolescence, and its prevalence increases with age. Although the most common causes of chronic or recurrent headaches in this group are benign primary headaches, migraine, and TTH, they may have a significant impact in children’s lives, disrupting school and social activities.

Appropriate management requires an individually tailored strategy giving due consideration to both nonpharmacologic and pharmacologic treatments. Reassurance, education, and information of patients and family are important intervention measures. Longitudinal studies have demonstrated that childhood migraine tends to improve with age and early diagnosis and intervention may be important to avoid persistence of symptoms.

In migraine, acetaminophen and ibuprofen are effective in the acute treatment of the attacks, but oral therapy can fail due to vomiting. Nasal sumatriptan, nasal zolmitriptan, and oral almotriptan have been approved for use in patients above 11 years of age. Supplementary measures such as rest in a quiet, darkened room are recommended. In chronic TTH, patients should be advised to take acute therapy only when the pain is severe, in order to avoid analgesic overuse.

Prophylactic management of migraine and TTH should include strategies relating to daily habits, family, school, and leisure-time activities. Nonpharmacologic treatments include relaxation training, biofeedback, cognitive-behavioral therapy, other psychotherapeutic approaches, or combinations of these treatments. Pharmaco-prophylaxis is indicated if headache are frequent and severe despite lifestyle modifications. Although many prophylactic medications have been tried in pediatric migraine, there are only a few medications that have been studied in controlled trials (particularly flunarizine and topiramate).

Multidisciplinary treatment is an effective strategy for children and adolescents with improvement of multiple outcome variants including frequency and severity of headache and school days missed because of headache.

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Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, A-1090, Austria

    Dr. Çiçek Wöber-Bingöl

  2. Unidade Neurológica de Investigação Clínica, Instituto Medicina Molecular (IMM), Lisbon Faculty of Medicine, Portugal Hospital de Sta Maria, Av. Professor Egas Moniz, Lisbon, 1649-028, Portugal

    Isabel Pavão Martins M.D., Ph.D.

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  1. Dr. Çiçek Wöber-Bingöl
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  2. Isabel Pavão Martins M.D., Ph.D.
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Correspondence to Çiçek Wöber-Bingöl .

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Editors and Affiliations

  1. Department of Medical and Molecular Sciences, School of Health Sciences, Sapienza University of Rome, Rome, Italy

    Paolo Martelletti

  2. Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway

    Timothy J. Steiner

  3. Department of Neuroscience, Faculty of Medicine, Imperial College London, London, UK

    Timothy J. Steiner

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Wöber-Bingöl, Ç., Martins, I.P. (2011). Managing Headache in Young People. In: Martelletti, P., Steiner, T.J. (eds) Handbook of Headache. Springer, Milano. https://doi.org/10.1007/978-88-470-1700-9_45

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  • DOI: https://doi.org/10.1007/978-88-470-1700-9_45

  • Publisher Name: Springer, Milano

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