Amitriptyline is an effective prophylactic medication for children with frequent headaches. A standardized dosing regimen results in a significant number of children responding with minimal side effects. The children are able to tolerate this dosing scheme and demonstrate good adherence to a dosing schedule of once a day.

The features of CDH in children most closely match those of migraine. A clear division of these children using frequency identifies three groups: frequent headaches (15 to 29), daily intermittent, and daily continuous. The daily continuous group is the most unique; however, the nature of these headaches continues to remain migrainous.

This report demonstrates that nasal sumatriptan may be effective in aborting migraine in young children (aged 5 to 12 years). It also suggests that there may be subgroups for which it works well. This information suggests that double-blind, placebo-controlled studies are necessary to determine the overall effectiveness of nasal sumatriptan in this age group.

Relaxation training and thermal biofeedback are promising treatments for pediatric headache. [1][2][3][4][5] This study evaluated the effectiveness of an hour-long, biofeedback-assisted relaxation training (BART) session within the context of a multidisciplinary pediatric headache center. The objectives were to determine whether peripheral body temperature (PBT) changes obtained during the training session (T1) could be maintained when measured at the child's subsequent follow-up clinic visit (T2), and to summarize headache perception and quality of life at T1 and T2.Methods. Twenty children consecutively referred for BART received standard multidisciplinary treatment and BART based on headache presentation and developmental status. The sample consisted of 10 girls and 10 boys, with a mean age of 11.6 years (SD ϭ 2.2 years). The sample was predominantly white (95%). All children were clinically diagnosed with migraine, with 90% meeting International Headache Society criteria. The sample was representative of the general population of the headache center 6 and those children referred for BART.Children were taught age-appropriate skills in deep breathing, progressive muscle relaxation, and guided imagery. PBT was monitored via a computer-based biofeedback system. Children were encouraged to practice with an audio tape at least three times each week (for 2 weeks) and at headache onset. Thereafter, the children were instructed to perform relaxation regularly on their own.PBT was measured at three time points: pretraining (PT), T1, and T2. At PT, PBT was measured before any relaxation training had occurred. At T1, PBT was measured before and after BART. At T2, PBT was assessed at the beginning of the clinic visit (prerelaxation) and 10 minutes after being instructed to "relax as you normally do" (postrelaxation). T2 data were collected at the child's first or second follow-up clinic visit after BART and before examination by members of the headache center team. The time from T1 to T2 averaged 150.7 days (SD ϭ 77.3 days). Changes in PBT (PBT ⌬) were calculated for T1 and T2 by subtracting PBT at pretraining/ relaxation from PBT post-training/relaxation. For 85% of the sample (n ϭ 17), we were also able to calculate PBT ⌬ at PT.Results. Results show that children were not able to significantly increase their PBT before BART (mean PBT ⌬ at PT ϭ 0.27°F; SD ϭ 0.70°F). However, once trained in BART, a positive change in PBT occurred at T1 (mean ϭ 3.3°F; SD ϭ 2.5°F) and T2 (mean ϭ 3.7°F; SD ϭ 4.5°F). Within-subject t-tests showed that changes were significant from PT to T1 (t ϭ Ϫ4.087; p Ͻ 0.01) and from PT to T2 (t ϭ Ϫ2.687; p Ͻ 0.02). PBT changes were maintained from T1 to T2 (t ϭ Ϫ0.427; NS: df ϭ 19). Ninety percent of children at T1 and 95% at T2 were able to obtain a positive change in PBT.Headache severity decreased from a mean of 5.0 (0 to 10 scale; 10 ϭ most pain) at T1 to 4.5 at T2. Average headache frequency decreased from 12.9 to 9.7 days/month, and duration also decreased from 6.9 to 5.2 hours. PBT ⌬ at T2 was s...