Developmental issues related to the assessment and treatment of childhood headache are discussed from the Department of Psychology, University of South Alabama, Mobile, Alabama. The three major areas of development are cognitive, self-regulation, and psychosocial development. Young children use “what”, “where”, and “who” before they can use “how𠇞, “why”, and “when”. “What is a headache?” is more likely to produce an intelligible response than “How do people get headaches?” Knowing the child’s explanation of headache will help provide better explanations of medical and psychological procedures for children. Children’s reports of the quality of headache pain are variable and may be exaggerated in the 9 to 11 age group and minimized in the 6 to 8 year olds. The headache record is the predominant outcome measure for determining treatment success, and the diary format should divide the day according to relevant and easily remembered events of meals and bedtime. An open ended format for measuring intensity such as a vertical thermometer scale is preferred to a fixed response scale of 0-5 that assumes equal increments in intensity. Headache duration might be compared to the length of a favorite television show, recess, or other activity rather than actual time estimates which may be problematic for children. “Before” and “after” are confusing for preschoolers although they understand the concepts of “first” and “last”.

A shift from an external health locus of control to the acknowledgement of one’s own role in headache control occurs with increasing age. Treatments that incorporate self-regulation such as autogenic thermal feedback training require an understanding of an internal control mechanism. From a medical perspective the foundation for self-management and self-regulation of behavior develops as the child applies autonomy to managing the external world. Awareness of autonomy, initiative and industry issues may facilitate successful treatment of childhood headache. A shift in family attention to headache free days could be a strong treatment reinforcer for children, focusing less attention on the headaches. [1]

COMMENT:. Adding a developmental perspective to psychological interventions in the management of childhood headache is likely to increase treatment effectiveness. The management of headache in children is different from that of adults and re-quires an assessment of cognitive and affective development and a knowledge of children’s concepts of illness and pain. Factors in precipitating headaches such as diet and exercise may be more important in children than in adults and will require special attention. The use of long-term investigational medications in children is undesirable and relaxation techniques and dietary modification may be more effective and appropriate.