Special Interest Group on Pain in Childhood
Pediatric Pain Letter

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Deirdre E. Logan, PhD
Children's Hospital Boston
Boston, USA

Associate Editor:
Abbie L. Jordan, PhD
University of Bath
Bath, UK

Copyright © 2021,
Special Interest Group on
Pain in Childhood,
International Association
for the Study of Pain®,

ISSN 1715-3956

Information appearing in Pediatric Pain Letter is not reviewed by, and is not necessarily endorsed by, the Special Interest Group on Pain in Childhood, nor by IASP ®.

Vol. 23 No. 2

June 2021

Book Review

A practical approach to pediatric headache management

Getting ahead of pediatric headaches: a comprehensive guide for nurse practitioners to manage headaches in children and adolescents

Karian VE (2020). Framingham, MA: Damianos Publishing, 194 pp. ISBN 978-1-941573-23-5 (Paperback: $30.00 USD). Link

Reviewed by Angelina Koehlert

printable version (PDF)

Victoria Karian, RN, MSN, CPNP has successfully created a comprehensive guide to managing one of the most common neurological disorders seen in pediatric neurology. This is no small task as pediatric headache disorders are often under-recognized and poorly treated. Lack of knowledge among healthcare providers is the principal clinical barrier. Many people with headache disorders are not diagnosed and treated: worldwide only 40% of those with migraine or tension type headache are professionally diagnosed, as are only 10% of those with medication overuse headache. Appropriate treatment of headache disorders requires training of healthcare professionals with regards to accurate diagnosis, recognition of the conditions, use of evidence-based medications, simple lifestyle modifications, and patient education.

Chronic pain and illness workbook for teens weighs in at about 150 pages and aspires to communicate facts about chronic pain before going on to cover many of the cognitive-behavioral therapy (CBT) techniques that are involved in evidence-based pediatric pain management. The book is straightforward and written in an amiable, upbeat tone that speaks directly to the young person and avoids being patronizing. The book has relatively few illustrations but strives to be interactive, breaking the text regularly with prompt questions and response boxes; clearly the author hopes for active personal engagement rather than passive reading. Tables and worksheets are here in number, and extra online resources include a range of recordings of techniques such as relaxation and imagery scripts.

The book starts by providing a clear process for the clinical evaluation of a patient presenting with headaches. Then the author reviews the specific diagnostic criteria for the numerous headache types. Each headache type includes well laid out case studies commonly seen in practice to help the practitioner understand the complexities and steps necessary for the effective diagnosis and treatment. Ms. Karian also provides detailed and effective treatment plans.

The book then moves into the three-tiered approach to effectively treating and managing pediatric headaches. The author begins with the foundation of all good pain management – lifestyle management. She reviews the approaches in promoting headache-healthy lifestyle as well as stress management techniques to reduce the negative impact lifestyle factors can have on triggering headaches. The next tier of management is preventative treatment. Here Ms. Karian did a wonderful job of covering both nutraceutical options like dietary supplements as well as more traditional pharmacological ones. Lastly, she discusses acute treatment options. The numerous charts provided throughout this section of the book are incredibly helpful in understanding the various treatment options including drug classes, formulations, recommended doses, side effects and mechanisms of action. There is also a section on more advanced treatments, such as Botox and CGRP medications to help manage chronic and intractable migraines. The author also discusses various comorbid conditions, such as psychiatric disorders, that can complicate headache treatment.

The last part of the book is very pragmatic and provides an excellent resource for all practitioners, not just nurse practitioners, in the management of headaches. This is one of the most useful parts of the book. Ms. Karian provides information on how to provide recommendations for Section 504 plans for accommodations in school, transitioning from pediatric to adult neurology care, as well as advice to offer college-bound migraineurs. The book has a large collection of worksheets and handouts that can be copied and provided to families so that they can better understand many teaching points including diagnostic information on the numerous headache types, management plans, lifestyle management recommendations, and stress reduction resources. There are also diaries to facilitate symptom tracking.

These handouts summarize the information provided throughout the guide in a clear and easy to understand manner so that families will have the resources they need to better manage their child’s headaches.

In writing Getting ahead of pediatric headaches: a comprehensive guide for nurse practitioners to manage headaches in children and adolescents, Ms. Karian has provided a wealth of practical information for pediatric providers to better assess, correctly diagnosis and treat headaches. This book will help to contribute to the growing body of work to better recognize and treat pediatric headache.

Angelina Koehler, MA, MSN, CPNP
Department of Neurology, University of Colorado; The Children's Hospital of Colorado, Denver, CO USA
email:  angelina.koehler[at]childresncolorado.org

Cite as: Koehler A. A practical approach to pediatric headache management. Book review: Getting ahead of pediatric headaches: a comprehensive guide for nurse practitioners to manage headaches in children and adolescents. Pediatric Pain Letter 2021;23(2):43-44. ppl.childpain.org