BOSTON—Children and adolescents with chronic daily headache and new daily persistent headache frequently overuse medication, which leads to excessive school absences, according to research presented at the 50th Annual Scientific Meeting of the American Headache Society. The incidences were similar for both types of headache, which suggests that they may be closely related, despite the difference in onset.
Sari Tepper, a Weller Scholar, and A. David Rothner, MD, Chairman Emeritus of the Section of Child Neurology and Director of the Pediatric/Adolescent Headache Program at the Cleveland Clinic, conducted a chart review of children and adolescents with chronic daily headache and new daily persistent headache. Criteria for chronic daily headache included a frequency of more than 15 days per month, a history of increasing headache frequency with decreasing severity of migrainous features for at least three months and/or history of episodic migraine, and mild or moderate intensity. New daily persistent headache was defined as occurring more than 15 days per month, no significant history of previous tension-type headache or migraine, acute onset (developing for up to three days) of constant unremitting headache, and consistency in location. Analgesic medication overuse was defined as more than three doses per week for six weeks and excessive school absence as more than 15 absences.
Among 89 patients, 28 (31%) were male. Patients were ages 4 to 18—mean age, 13.2 for those with chronic daily headache and 12.8 for those with new daily persistent headache. New daily persistent headache occurred in 38 patients (43%; 29% male) and chronic daily headache in 51 patients (57%; 33% male).
Nearly 60% of participants overused OTC medication, and 40% missed excessive amounts of school. Medication overuse occurred in 54% of patients with chronic daily headache and in 63% of subjects with new daily persistent headache. About 39% of patients with each type of headache had excessive school absence. Concomitant medication overuse and excessive school absences were observed in 27% of the chronic daily headache group and 26% of the new daily persistent headache group.
No patients with chronic daily headache had a headache duration of less than one month, compared with 18% of patients with new daily persistent headache—one to three months’ duration occurred in 29% and 45% of the two groups, respectively; four to 11 months’ duration in 22% and 21% of the two groups, respectively; and up to 12 months in 49% and 16% of the two groups, respectively.
“Most chronic daily headaches, including new daily persistent headache, can be improved by stopping the overused medication,” reported Ms. Tepper and Dr. Rothner. “Patients tend to have long-term improvement after detoxification.” Also, parents may give too much attention to a child’s sick behavior by allowing him or her to escape responsibilities such as school, the researchers said. This can lead to falling behind in school, “which in turn may worsen the headaches.”