How is pediatric chronic daily headache (CDH) treated?

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

As previously mentioned, the treatment of CDH combines therapies that are used for tension and migraine headache. The patient should discontinue the use of OTC analgesics and all narcotics. Chronic, intermittent analgesic use may result in medication-overuse headaches. Tricyclic antidepressants appear to be most helpful for treating CDH in children. There are also data on topiramate and CDH. [52, 53, 54]

Psychological, behavioral, and relaxation interventions are also beneficial. Consider using these techniques concomitantly with tricyclic antidepressants. When the CDH pattern includes well-defined migraine attacks, abortive therapy may provide symptomatic relief. Late in 2012, the National Institutes of Health funded a study called CHAMP (CHildhood and Adolescent Migraine Prevention); the study was terminated early after interim analysis showed no significant difference in responder rates between subjects who received amitriptyline, topiramate, or placebo, and the occurrence of adverse events in patients who received study drug. However, neurologists continue to utilize these medications, as they have anecdotal observations of benefit. [55]


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