MARK S. SCHWARTZ
Headaches are surprisingly common in children. Even at the young age of 3, headaches are present in 3–8% of children. This increases to about 20% at age 5, 37–52% at age 7, and 57–82% from ages 7 to 15 (see Lipton, Maytal, & Winner, 2001, for a review). A U.S. study included 3158 children ages 12–17 whose families were contacted by telephone (Linet, Stewart, Celentano, Ziegler, & Sprecher, 1989). Among the many findings were that 56% of the males and 74% of the females reported a headache in the past 4 weeks; 27% of the males and 41.4% of the females reported two or more headaches; and 4.5% of the males and 9.4% of the females reported four or more headaches in the past month. The average intensity was moderate on a 1–10 scale (4.5 for males, 4.7 for females), and the mean duration was 5–6 hours. The pain and suffering children experience can have a significant impact on every aspect of their daily lives (Bandell-Hoekstra, Abu-Saadm, Passchier, & Knipschild, 2000).
Many continue to believe that pediatric headache does not need to be taken seriously, because it will be outgrown with time. Regrettably, this does not hold true for many children so affected, as revealed by the longitudinal work of the Swedish pediatrician Bo Bille and others. Nearly five decades ago (the mid 1950s), Bille began a landmark study of about 9000 Swedish schoolchildren ranging in age from 7 to 15; his first publication (Bille, 1962) told us much about headache occurrence across gender and age. Bille was able to follow a subset of these children, all of whom were diagnosed as having migraine at a very young age, for 40 years. The majority continued to be troubled by headaches at this final follow-up assessment (Bille, 1997). Subsequent work has confirmed the enduring nature of childhood headaches (e.g., Larsson, 2002; Sillanpää, 1994; Waldie, 2001), and has reinforced the importance of early intervention for ameliorating current symptoms and preventing adult symptoms. Furthermore, there are indications that childhood headaches have increased in prevalence over the past decades (Sillanpää & Anttila, 1996).
Diagnosis and medical evaluation for pediatric patients with headache proceeds much as it does for adult patients (Holden, Levy, Deichmann, & Gladstein, 1998; Rothner, 2001). We