[Prophylactic treatment of headache].
BACKGROUND
Headache continues to be the commonest neurological disorder of childhood. There are few studies of prophylactic treatment for headache at this age, perhaps because of the difficulty in measuring intensity of pain and response to treatment in children. Before headache can be treated prophylactically, it is necessary to know its exact site and main trigger mechanisms. Therefore, treatment has to be adapted to the individual, bearing in mind the age of the patient, frequency of headaches, presence or absence of aura, intensity of pain and attitude of the family. Behavior therapy, psychological support and relaxation exercises may be necessary to reduce the frequency and intensity of the headache.


METHODS
The first prophylactic treatment for chronic headache should be identification of any underlying trigger factor. Tension type headache may be a simple somatic reaction to stress. Prophylactic drugs should be given according to the frequency of headaches, their duration and intensity whenever drug treatment for the acute phase has not eased the pain completely. The tricyclic antidepressants are the initial drug of choice for use in tension headache. It should be remembered that in children drugs should only be used when other measures of pain control have proved useless. In general prophylactic treatment of migraine should be started as monotherapy, maintained for at least one month (approximately between 3 and 6 months) before gradually stopping the drug. The drugs usually used in children are adrenergic beta blockers, calcium antagonists, seretoninergenic antagonists, antidepressants, non steroid anti inflammatory drugs, and the anti convulsant drugs currently being developed.
Rufo-Campos
M
M
Sección de Neurología Infantil; Hospital Universitario Virgen del Rocío, Sevilla, 41013, España. mrufo@nacom.es
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006261:Headache / Q000188:drug therapy / Q000517:prevention & control*; D006801:Humans; D007223:Infant