Commentary: the pediatric migraine connection

Should biobehavioral intervention be the first treatment option considered by pediatricians and pediatric neurologists in the management of recurrent headache disorders of childhood? I believe the answer is, yes. Not one but several treatment techniques falling under the biobehavioral rubric have produced clinically significant results for most headache subtypes in children. Furthermore, these techniques are well described, readily implemented by properly trained clinicians (with the possible exception of biofeedback), and complementary to medical therapy. Perhaps, most important in the era of managed health care, treatment is typically short-term. So why, after 18 years of clinical experience and 31 published investigations later, is biobehavioral intervention not highly visible in the treatment armamentarium for pediatric headache syndromes?