The long-term effectiveness and outcome of multidisciplinary treatment of childhood headaches were evaluated at 1, 2, and 5 years at the Cincinnati Children’s Hospital Medical Center, OH. Diagnosis was based on clinical impression and ICHD criteria. Data on severity, frequency, duration, participation in activities during headaches, effect of treatment, and school days missed were collected from clinic follow-up questionnaire or via telephone. The team-based treatment plan included acute, prophylactic, behavioral therapy, and teaching. Bio-behavioral therapy included changes in diet, hydration, sleep pattern, and activity. Days of school missed were used as a disability measure; a marked decrease occurred from 4.5+/-9.5 at initial visit to 1.55+/-2.8 at 5 years (p<0.001). Headache frequency was 13.4/month initially, 4.9 at 1 year, 4.7 at 2 years, and 4.5 at 5 years (p<0.001). Headache severity was also significantly decreased. Patients with less frequent and shorter duration headaches at initial visit were less likely to return for follow-up, but continued to do well at 5-year assessment. 
COMMENT. Children with more severe migraine headaches at initial presentation should benefit from a regular multidisciplinary treatment plan.
Topiramate was effective in reducing the frequency and severity of chronic daily headache in 62% of 21 patients, ages 6-18 years, using a low dose (average 30/mg/day).