The benefits of brief neurologist-administered behavioral treatment of pediatric episodic tension-type headache were determined at the University of West Florida, Pensacola, FL. Thirty seven children, 26 females and 11 males, mean age 12.3 years (range 9-16 years), with a minimum of one headache per week, were included. Patients kept daily headache diaries for monthly periods, before treatment and at follow-up at 1, 3, 6, and 12 months. Days of headache activity, analgesic tablet counts, and responder rate were the main outcome measures. Patients were seen for a maximum of 30 minutes in groups of 3 to 5, once per week for 8 weeks. Sessions consisted of a review of the prior week, analysis of and coping with headache-eliciting situations, and practice of progressive muscle relaxation training with 8 muscle groups. The first session was tape recorded to guide home practice, and the tape was used once per day during treatment and twice per week thereafter. The treatment sessions were designed by a behavioral psychologist. Improvements, except for the use of analgesics, were significant and persisted through 1 year follow-up. Analgesic tablet consumption was reduced by more than 50%, but the reduction was not significant. 
COMMENT. Neurologist administered, group treatment sessions involving muscle relaxation exercises and discussion of headache-eliciting situations may offer an alternative to supplemental medication in children with tension-type headaches. Since the behavioral psychologist designed and is trained to conduct group therapy, it may be more appropriate and cost-effective to refer the patient for this form of management.
Attention to the diet factor is another complementary method of management of chronic headache, especially for migraine headaches. Long-term prophylactic drug therapy should be avoided until headache-precipitating trigger factors, including dietary factors have been excluded. 
Premonitory symptoms in migraine. Electronic diaries were used in a 3-month multicenter study to record nonheadache symptoms before, during, and after migraine, that might predict an attack. Patients correctly predicted migraine headaches from 72% of diary entries with premonitory symptoms. Nonheadache, premonitory symptoms included feeling tired (72%), difficulty concentrating (51%), and stiff neck (50%). Migraineurs who report premonitory symptoms that impair daily activities can accurately predict an impending attack.