With a patient, pediatric neurologist Christopher Oakley.

Headaches are the most frequent reason for referrals to pediatric neurologists, yet very few specialize in this condition. Filling that void are Christopher Oakley and his physician assistant, Candie Marchand, who recently started Johns Hopkins’ Pediatric Headache Clinic, one of the few such centers in the country.

While researchers are working toward gaining a better understanding of headaches, it’s still unclear what causes them, and there is no cure—only ways to manage the pain and prevent onset. Working toward that goal, Oakley and Marchand use a three-pronged approach. First they help patients attain a healthy lifestyle through good hydration, exercise, a healthy diet and sufficient rest, to help prevent headaches before they start. Next, based on each patient’s lifestyle, they suggest some alternative therapies, such as physical therapy, meditation, biofeedback and behavioral therapy.

“There’s also good evidence that some supplements have benefits,” Oakley says.

For example, some of his patients take magnesium, vitamin B2, coenzyme Q10, feverfew and butterbur, all shown to lessen headaches in clinical trials.

Finally, if these approaches don’t significantly reduce the number and severity of a patient’s headaches, Oakley and Marchand prescribe preventive drugs for daily use and abortive drugs for acute headaches.

“I stress to patients and their families that medicines are not a cure. Our best hope is to decrease the headache frequency and severity,” he says. “If we decrease their headaches by 50 percent, that’s a success.”

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