Treatment of episodic and chronic tension-type headache in children and adolescents

Children frequently suffer from migraine or tension-type headaches, and the headache pain not only interferes with a patient’s life but can affect his entire family. Headache management includes not only pharmacological agents but also a complete assessment of the patient’s life-style and possible stressor factors, as well as an accurate assessment of his or her present episodic therapy. Stress may play a role in precipitating headache attacks, and it is crucial to keep in mind that school and interpersonal relationships are the most significant stressor factors in the adolescent life. Several factors must be considered to achieve successful treatment. The medication must be given as early as possible and the dose administered must be sufficient. Paracetamol can still be considered as the treatment of first choice. Ibuprofen and acetylsalicylic acid should be used in patients refractory to paracetamol. There are no controlled studies on the pharmacological prophylaxis of tension-type headache in children and adolescents. However, amitriptyline may be used considering its efficacy in adults and some experience with this compound in other conditions in childhood and adolescence. In children with a disturbed home life, significant depression, or abuse, family and individual psychoterapy are indicated.