A Generalist-Deliverable Bio-Psycho-Social Model for Pediatric Chronic Daily Headache: A 24-Month Retrospective Study.

BACKGROUND

Chronic daily headache (CDH) in youth is a functionally disabling and diagnostically heterogeneous condition that often requires multifaceted intervention. Real-world care is frequently fragmented-either limited to pharmacologic management or constrained by limited access to behavioral services. We evaluated the effectiveness of a generalist-deliverable bio-psycho-social (BPS) management model for children and adolescents with CDH, addressing both pharmacologic and contextual factors in the absence of subspecialty mental health services.

METHODS

This retrospective, single-center observational study included 37 pediatric patients diagnosed with CDH according to ICHD-3 criteria. All participants received a structured BPS model delivered by general pediatricians. The model comprised (1) feature-guided pharmacologic treatment, (2) narrative-based psychosocial dialog, and (3) gradual school reintegration. Headache frequency, school attendance, and Pediatric Migraine Disability Assessment-assessed disability were evaluated at baseline, 6 months, and 24 months.

RESULTS

By 6 months, only 13.5% of patients met CDH criteria; by 24 months, this decreased to 5.4%. Headache frequency, school attendance, and disability scores improved significantly (P < 0.001 for all). Improvements occurred across diagnostic subtypes and were not solely dependent on pharmacologic treatment, underscoring the contribution of nonpharmacologic components. Functional recovery-particularly school attendance-often lagged behind symptom resolution.

CONCLUSIONS

A generalist-deliverable BPS model was associated with sustained improvement in CDH outcomes, even in the absence of subspecialty resources. This pragmatic framework may support individualized, function-centered care for pediatric CDH in real-world settings.