Monthly variation of United States pediatric headache emergency department visits.

OBJECTIVE: The objective of this article is to determine the monthly variation of emergency department (ED) visits for pediatric headache. We hypothesized youth have increased headache-related ED visits in the months associated with school attendance. METHODS: Using a United States representative sample of ED visits in the National Hospital Ambulatory Medical Care Survey from 1997 to 2009, we estimated number of visits associated with ICD-9 codes related to headache, migraine, status migrainosus, or tension-type headache in 5- to 18-year-olds. Age-stratified multivariate models are presented for month of visit (July as reference). RESULTS: There was a national estimate of 250,000 ED visits annually related to headache (2.1% of total visits) in 5- to 18-year-olds. In 5- to 11-year-olds, the adjusted rate of headache-related visits was lower in April (OR 0.42, 95% CI 0.20, 0.88). In 12- to 18-year-olds, there were higher rates in January (OR 1.92, 95% CI 1.16, 3.14) and September (OR 1.64, 95% CI 1.06, 2.55). CONCLUSIONS: In adolescents we found higher ED utilization in January and September, the same months associated with school return from vacation for a majority of children nationally. No significant reduction in the summer suggests that school itself is not the issue, but rather changes in daily lifestyle and transitions.

Intravenous magnesium as acute treatment for headaches: a pediatric case series.

BACKGROUND: Acute i.v. treatment for pediatric headache varies widely. OBJECTIVES: Our aim was to describe our experience with i.v. magnesium for acute treatment of pediatric headache. METHODS: We reviewed the electronic medical records of all patients ages 5 to 18 years old treated with a standard dose of i.v. magnesium for headache at our institution from January 2008 to July 2010. Charts were assessed for headache diagnosis, prior medications given, side effects, tolerability, and response to treatment. Individuals were excluded if they had an underlying unstable medical condition or a secondary etiology for headache. Only first encounters were included if the patient had multiple encounters. RESULTS: There were 34 episodes of children who received i.v. magnesium in the emergency department (ED) or hospital. Of these, 14 were excluded because the patients had complex medical conditions (n = 6), they were repeat encounters (n = 7), or known secondary etiology for the headache (n = 1). Of the 20 included charts (range 13-18 years old), 5 had migraine, 4 had tension-type headache, and 11 had status migrainosus. Thirteen were treated in the ED and seven as an inpatient with a standard i.v. dose of magnesium. Ten of thirteen adolescents receiving i.v. magnesium in the ED were admitted for further headache treatment but not for side effects, and three were discharged home. Side effects of treatment included pain (1 of 20), redness (1 of 20), burning (1 of 20), and decreased respiratory rate without change in oxygenation (1 of 20). CONCLUSIONS: In our case series, adolescents given i.v. magnesium as an abortive therapy for headache experienced minimal side effects and further studies should evaluate for effectiveness.

Late cytotoxic edema in 2 children with hemiplegia: hemiplegic migraine or stroke?

Hemiplegic migraine (HM) is a rare variant of migraine with aura, characterized by migrainous headache and fully reversible motor deficit within 24 hours. Both sporadic and familial forms of HMs are genetically heterogenous with little information on neuroimaging during and after acute attacks. We report 2 cases of children with presumed HM and late cytotoxic edema.

Complementary and Integrative Approaches for Pediatric Headache.

In this article, the use of complementary and integrative medicine for the management of pediatric headache is reviewed. Despite limited numbers of studies for pediatric headaches, children and families seek these services. Integrative medicine focuses on treating the whole person, integrating conventional medicine with mind-body-spirit methods. Nutriceuticals include dietary supplements in the form of vitamins (vitamin D), minerals (magnesium), coenzyme Q, butterbur, and melatonin. Acupuncture, stimulation, physical therapy and Transcutaneous Electrical Nerve Stimulations (TENS) or Transcranial Magnetic Stimulation (TMS) may also be useful in selected patients. The efficacy of all these therapeutic alternatives in pediatric headache is presented here. Primary care providers, neurologists, and headache specialists alike need to be informed of such interventions and integrate these approaches, when appropriate, in the management of children with headaches.

Dizziness and Orthostatic Intolerance In Pediatric Headache Patients.

Children and adolescents with headaches commonly complain of dizziness that creates significant distress among the patients and their families. Dizziness is largely due to either orthostatic intolerance or vertigo; this distinction is the initial step in the evaluation of a child with co-occurrence of headaches and dizziness. Vertiginous symptoms are most commonly due to vestibular migraine or benign positional vertigo. This review would focus its attention on the diagnosis, evaluation, and management of orthostatic intolerance, specifically postural orthostatic tachycardia syndrome.

Pediatric neurological complications of 2009 pandemic influenza A (H1N1).

OBJECTIVE: To analyze the spectrum of neurological manifestations in children hospitalized with pandemic influenza A H1N1 virus of 2009 (pH1N1). DESIGN: Retrospective case series of children hospitalized from May 1, 2009, through November 30, 2009. SETTING: Tertiary-care children's hospital in Colorado. PATIENTS: All hospitalized patients with pH1N1 with neurological consult or diagnosis, lumbar puncture, electroencephalogram, or neuroimaging were selected as suspected cases. These were systematically reviewed and selected for final analysis if confirmed by pre-established definitions as a neurological complication. RESULTS: Of 307 children with pH1N1, 59 were selected as having suspected cases of neurological complications. Twenty-three children were confirmed to have a neurological complication. Of these 23, 15 (65%) required intensive care monitoring. The median length of stay was 4 days. Seventeen (74%) had a preexisting neurological diagnosis. The most common manifestation was seizure with underlying neurological disease (in 62% of cases) followed by encephalopathy with or without neuroimaging changes (in 26% of cases). Results from a lumbar puncture showed elevated protein levels in 3 of 6 patients but no significant pleocytosis. Seven of the 9 electroencephalograms showed diffuse slowing, and findings from magnetic resonance imaging were abnormal in 5 of 6 children. Deaths occurred in 13% of patients, and short-term disability in 22%. CONCLUSIONS: Children infected with pH1N1 presented with a wide spectrum of neurological manifestations, which occurred primarily in individuals with preexisting neurological conditions. These individuals had a severe disease course, evidenced by need for intensive care services and relatively high rates of mortality or neurological disability. Children with underlying neurological conditions should be particularly targeted for influenza prevention and aggressive supportive treatment at the onset of influenzalike symptoms.