Chronic daily headache in the pediatric population.

Very limited long-term follow-up data exist for the population of children and adolescents with chronic daily headache (CDH). One abstracted report discusses short-term follow-up on 24 adolescents (peak age 13 years) with CDH; in a 6-month follow-up, more than 50% experienced a reduction of 75% or more in headache frequency, and one third showed an improvement of greater than 90% in headache frequency. A wide variety of preventive agents were used, but amitriptyline and topiramate provided the largest percentage of successful outcomes. With an improving classification scheme, we have the possibility of using multicenter studies to elucidate whether the clinical patterns seen by experienced observers translate into rational differentiation of treatment approaches. If the entities of CDH are, indeed, different, then therapeutic, prophylactic, and behavioral trials could guide us in offering a more evidence-based approach to the treatment of this fascinating, yet sometimes debilitating condition.