[Headache in children: also a problem for child and adolescent psychiatry? Pathogenesis, comorbidity, therapy]

Abstract

Headache is a recurrent somatic complaint in childhood and adolescence. In recent decades headache prevalence has increased while the age of onset has decreased. In most cases headache can be categorized as migraine or tension-type headache without significant organic pathology, i.e. head trauma, structural lesion, etc. Diagnosis according to the criteria of the International Headache Society is based on subjective reports by patients and their parents. The basic tools of clinical assessment are history, physical examination and a headache diary. Laboratory tests, including electroencephalography and imaging studies should not, as a rule, be undertaken routinely. Pathophysiological models with an impact on therapeutic interventions will be discussed. Childhood headache is often treated inappropriately in daily practice despite the availability of various options (including environmental, drug, and psychological therapy). Psychological therapy (relaxation training, biofeedback, stress management, etc.) as well as medication can be applied for prophylaxis. Minimal therapeutic interventions have been shown to be equally effective in a remarkable number of patients. Chronic Headache shows relevant comorbidity with anxiety and depression and is associated with somatization and school disorders. A careful investigation and an adequate therapy of eventual psychiatric comorbidity is therefore strongly recommended.