Medication-Overuse Headache in Children: Is Initial Preventive Therapy Necessary?

Eric H. Kossoff, MD; Dhwani N. Mankad, MPH, MBBS

Disclosures

J Child Neurol. 2006;21(1):45-48. 

In This Article

Methods

The records were reviewed of 43 patients with medication-overuse headache followed in a pediatric neurology clinic by a single provider (E.H.K.) over a 24-month period from October 2002 to September 2004 in which follow-up by clinic visits or telephone was documented. Headaches occurred in the fall and winter season (September to March) in 73% of patients. Patients ranged from 6 to 17 years of age (mean 12.6 years), and follow-up was established for at least 3 months in those included in the evaluation. These patients ranged in age from 8 to 17 years and were similar in all aspects to the other 43 children.

All patients were advised to discontinue analgesics, avoid caffeine-containing products, obtain regular sleep, start an exercise program, and avoid any identified headache triggers. The decision to start anti-migraine therapy at the initial visit was made in conjunction with the patient's and family's wishes and was not a systematic or algorithm-based choice. However, all patients were able to remain on their therapy option (either preventive therapy or solely lifestyle changes) for at least 1 month. Patients were contacted by telephone or evaluated in clinic at 1 month after the initial contact. Outcomes were classified as either headache free, 90% reduction (headaches now weekly), 50% reduction (every other day), or less than 50% improvement. The duration and intensity of individual headaches were not consistently documented.

This study was granted exemption from the Institutional Review Board because it was retrospective and presented no risk to patients. Categorical data were analyzed using Pearson's chi-square for independence of rows and columns. Means were compared using a Wilcoxon two-sample test. The significance level for all tests was P = .05.

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