Material and methods: Study design: Prospective, observational, and sequential. Setting: Private practice Pediatric Neurology Clinic in a Canadian city (Winnipeg). Patients and data collection: Data

(CDH) in adults. The International Headache Society (IHS) Classification,2,3 does not incorporate CDH as a separate entity. Silberstein et al4 proposed a classification for CDH; they recognized that further modifications to their proposal would occur. Gladstein et al5 highlighted the need to study CDH in ABSTRACT: Objective: Characterize chronic daily headache in those less than 20 years of age. Material and methods: Study design: Prospective, observational, and sequential. Setting: Private practice Pediatric Neurology Clinic in a Canadian city (Winnipeg). Patients and data collection: Data on those referred with headache between September 1998 and December 2001 were entered on data sheets. Patients were followed up for one month to four years. Results: One hundred and forty-three (31%) of 463 referred with headache had chronic daily headache with duration of one month to five years (median: eight months). The age range was 5.5 years to 20 years (median: 13 years). There were significantly more females (N=93) than males (N=50). The main groups were: (1) transformed migraine: 6 (4%), (2) transformed tension-type headache: 80 (56%) and (3) transformed comorbid migraine and tension-type headache: 39 (27%). Tension-type features dominated in 94%. Analgesia overuse occurred in two. Stressors were recognized in 60 (42%); anxiety disorder was diagnosed in 8 (6%), and depression in 13 (9%). Computed tomography scans were done in 31 (22%), and MRI/MR angiography in 8 (6%) and were normal or showed nonspecific incidental findings. Twenty-two (15%) were lost to follow-up; 115 of the remaining 121 (95%) were headache free or greatly improved, 63 (55%) without specific treatment. Conclusions: Chronic daily headache is a common headache disorder in children and adolescents, especially in teenage girls. A prospective neuropsychiatric approach is necessary for evidenced-based management, since the condition has mental health, social and economic ramifications.