What is the prognosis of pediatric headache?

Updated: Jan 02, 2019
  • Author: J Ivan Lopez, MD, FAAN, FAHS; Chief Editor: George I Jallo, MD  more...
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Answer

Long-term prognostic studies of pediatric headache are scarce, but Brna et al reported that at 20-year follow-up, 73% of pediatric headache patients in their study continued to suffer from headache. [27] In a follow-up study of 200 patients from a headache clinic over 6 years, 48% of initial migraineurs remained migraine sufferers; 26% became tension-type headache sufferers; and 26% became headache-free.

Similar numbers were observed for initial tension-type headache sufferers but with a slightly higher headache-free rate (41% remained with tension-type headache; 21% developed migraine; and 38% became headache-free).

Headache can cause significant disruption in a child's daily activities, and children with migraine headache are often not appropriately diagnosed and thus go untreated. In a large study looking at the prevalence of migraine headache, 31% of patients reported that they had missed at least 1 day of school or work in the previous 3 months. In this same study, more than half of patients reported that their productivity was reduced by 50%. Some authors believe that children and adolescents with recurrent migraines experience a reduction in their quality of life similar to that of children with cancer. [28]

Primary headache conditions are notorious for their waxing/waning course, and long-term follow-up care is usually necessary. Short-term remissions are not uncommon, but long-term ones are rare. The natural history and prognosis of migraine may follow one of the following 4 clinical patterns [29] :

  • Clinical remission - Some migraine sufferers may become symptom-free over prolonged periods.

  • Partial clinical remission - In others, migraines get less severe over time, resembling common migraine or tension-type headaches.

  • Clinical persistence - The frequency and severity of migraine headache does not improve but does not get worse either.

  • Progression - The frequency and severity of migraine headache gets worse

Early diagnosis and prompt initiation of optimal treatments (abortive and preventative) may lead to better treatment outcomes and prognosis and less disability for children and adolescents with migraine. [30]


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