American Headache Society (AHS): Annual Meeting

WASHINGTON – About a third of children with cyclic vomiting syndrome appear to have some metabolic condition, either mitochondrial dysfunction, fatty acid oxidation dysfunction, or a combination of both.

Unfortunately, there seems to be neither rhyme nor reason to the pattern. "Some showed the abnormalities only when well, some showed them only when acutely ill, and some showed them all the time," Dr. David Rothner said at the annual meeting of the American Headache Society.

Dr. Rothner, director of the Pediatric/Adolescent Headache Program at the Cleveland Clinic, and his colleagues presented the largest-to-date case series of metabolic testing in children with cyclic vomiting syndrome. Considered one of the three subtypes of migraine, cyclic vomiting is a debilitating illness with no known etiology and virtually no physical abnormalities that account for its occurrence.

The condition is a chronic disorder characterized by repeated, stereotypical vomiting episodes accompanied by severe nausea and sometimes by headache. The four components to the syndrome include: the prodrome, when severe nausea is present; the severe emetic phase; the postemetic phase; and the time between cycles, during which the patient is entirely well.

Most frequently, the vomiting episode begins between 4 and 6 a.m. "During a spell, a child can vomit every 10-15 minutes, for up to 2 days. There is more vomiting with this syndrome than in any other disease known to man."

Diagnosis can only be made by ruling out every possible physical cause. "Often, the time from the first episode until diagnosis can be 3 or 4 years, which is tragic," he said.

The prospective cohort consisted of 106 consecutive patients seen at the clinic from 2007 to 2010. Most were 8 or 9 years old, male (57%), and white (77%), and "most importantly, 26% had a personal history of migraine, which did not occur during the vomiting."

Most of the children (71%) also had a family history of migraine; 10% had a family history of epilepsy.

The episodes occurred an average every 4 weeks. The mean duration of the acute phase was 25 hours, with a mean of 18 vomits during that time, up to 5 per hour. "There was complete resolution of symptoms between the spells in 88% of these children," Dr. Rothner said.

Most children (73%) had a prodromal phase, usually abdominal pain and nausea. There were some identifiable triggers for 66%, including viral illness, and motion sickness. Along with vomiting, 25% of the children had some autonomic symptom, including fever and hypertension.

Of the 42 patients who underwent magnetic resonance imaging, 57% had normal results. "Some of them already had the abnormalities recognized before the disorder began, but none of them had anything to do with the vomiting," Dr. Rothner said.

He and his team also performed abdominal ultrasound on 41 children during the acute phase to rule out intestinal malrotation or volvulus. There were no gastrointestinal abnormalities related to vomiting. Likewise, esophagogastroduodenoscopies in 27 patients showed no serious issues, other than six cases of gastritis.

The investigators aimed to perform metabolic testing of blood and urine during both the well and ill phase in all children. At least some testing was accomplished in 58. One-third of the children tested during the ill or well phase, or during both, showed some sign of mitochondrial dysfunction or abnormal oxidation of fatty acid.

But the results were very difficult to interpret, Dr. Rothner said. "Of the 16 patients who had testing at both phases, 13 had abnormalities. But three showed mitochondrial dysfunction when well and not when ill, four had abnormalities when ill but not when well, and another three had some combination of mitochondrial and fatty acid dysfunction during both times. When we looked at the metabolic testing based on timing, we expected to find more abnormalities at the time of acute illness, but this was not the case. The results were not consistent."

There is no universally accepted treatment for the disorder. "Nothing controls it or makes it go away," Dr. Rothner said. For prophylactic treatment, about half of the group experienced some benefit from amitriptyline. During the acute phase, 85 children tried high-dose oral ondansetron, which improved or resolved symptoms in 66%.

Now, based on the metabolic testing, some of the children in the group also receive carnitine and coenzyme Q10, which Dr. Rothner said confers at least some benefit to about half the group.

The children are part of a continuous study which Dr. Rothner hopes will shed more light on the disorder’s connection with metabolic dysfunction.

He reported having no financial disclosures.

WASHINGTON – About a third of children with cyclic vomiting syndrome appear to have some metabolic condition, either mitochondrial dysfunction, fatty acid oxidation dysfunction, or a combination of both.

Unfortunately, there seems to be neither rhyme nor reason to the pattern. "Some showed the abnormalities only when well, some showed them only when acutely ill, and some showed them all the time," Dr. David Rothner said at the annual meeting of the American Headache Society.

Dr. Rothner, director of the Pediatric/Adolescent Headache Program at the Cleveland Clinic, and his colleagues presented the largest-to-date case series of metabolic testing in children with cyclic vomiting syndrome. Considered one of the three subtypes of migraine, cyclic vomiting is a debilitating illness with no known etiology and virtually no physical abnormalities that account for its occurrence.

The condition is a chronic disorder characterized by repeated, stereotypical vomiting episodes accompanied by severe nausea and sometimes by headache. The four components to the syndrome include: the prodrome, when severe nausea is present; the severe emetic phase; the postemetic phase; and the time between cycles, during which the patient is entirely well.

Most frequently, the vomiting episode begins between 4 and 6 a.m. "During a spell, a child can vomit every 10-15 minutes, for up to 2 days. There is more vomiting with this syndrome than in any other disease known to man."

Diagnosis can only be made by ruling out every possible physical cause. "Often, the time from the first episode until diagnosis can be 3 or 4 years, which is tragic," he said.

The prospective cohort consisted of 106 consecutive patients seen at the clinic from 2007 to 2010. Most were 8 or 9 years old, male (57%), and white (77%), and "most importantly, 26% had a personal history of migraine, which did not occur during the vomiting."

Most of the children (71%) also had a family history of migraine; 10% had a family history of epilepsy.

The episodes occurred an average every 4 weeks. The mean duration of the acute phase was 25 hours, with a mean of 18 vomits during that time, up to 5 per hour. "There was complete resolution of symptoms between the spells in 88% of these children," Dr. Rothner said.

Most children (73%) had a prodromal phase, usually abdominal pain and nausea. There were some identifiable triggers for 66%, including viral illness, and motion sickness. Along with vomiting, 25% of the children had some autonomic symptom, including fever and hypertension.

Of the 42 patients who underwent magnetic resonance imaging, 57% had normal results. "Some of them already had the abnormalities recognized before the disorder began, but none of them had anything to do with the vomiting," Dr. Rothner said.

He and his team also performed abdominal ultrasound on 41 children during the acute phase to rule out intestinal malrotation or volvulus. There were no gastrointestinal abnormalities related to vomiting. Likewise, esophagogastroduodenoscopies in 27 patients showed no serious issues, other than six cases of gastritis.

The investigators aimed to perform metabolic testing of blood and urine during both the well and ill phase in all children. At least some testing was accomplished in 58. One-third of the children tested during the ill or well phase, or during both, showed some sign of mitochondrial dysfunction or abnormal oxidation of fatty acid.

But the results were very difficult to interpret, Dr. Rothner said. "Of the 16 patients who had testing at both phases, 13 had abnormalities. But three showed mitochondrial dysfunction when well and not when ill, four had abnormalities when ill but not when well, and another three had some combination of mitochondrial and fatty acid dysfunction during both times. When we looked at the metabolic testing based on timing, we expected to find more abnormalities at the time of acute illness, but this was not the case. The results were not consistent."

There is no universally accepted treatment for the disorder. "Nothing controls it or makes it go away," Dr. Rothner said. For prophylactic treatment, about half of the group experienced some benefit from amitriptyline. During the acute phase, 85 children tried high-dose oral ondansetron, which improved or resolved symptoms in 66%.

Now, based on the metabolic testing, some of the children in the group also receive carnitine and coenzyme Q10, which Dr. Rothner said confers at least some benefit to about half the group.

The children are part of a continuous study which Dr. Rothner hopes will shed more light on the disorder’s connection with metabolic dysfunction.

He reported having no financial disclosures.

WASHINGTON – About a third of children with cyclic vomiting syndrome appear to have some metabolic condition, either mitochondrial dysfunction, fatty acid oxidation dysfunction, or a combination of both.

Unfortunately, there seems to be neither rhyme nor reason to the pattern. "Some showed the abnormalities only when well, some showed them only when acutely ill, and some showed them all the time," Dr. David Rothner said at the annual meeting of the American Headache Society.

Dr. Rothner, director of the Pediatric/Adolescent Headache Program at the Cleveland Clinic, and his colleagues presented the largest-to-date case series of metabolic testing in children with cyclic vomiting syndrome. Considered one of the three subtypes of migraine, cyclic vomiting is a debilitating illness with no known etiology and virtually no physical abnormalities that account for its occurrence.

The condition is a chronic disorder characterized by repeated, stereotypical vomiting episodes accompanied by severe nausea and sometimes by headache. The four components to the syndrome include: the prodrome, when severe nausea is present; the severe emetic phase; the postemetic phase; and the time between cycles, during which the patient is entirely well.

Most frequently, the vomiting episode begins between 4 and 6 a.m. "During a spell, a child can vomit every 10-15 minutes, for up to 2 days. There is more vomiting with this syndrome than in any other disease known to man."

Diagnosis can only be made by ruling out every possible physical cause. "Often, the time from the first episode until diagnosis can be 3 or 4 years, which is tragic," he said.

The prospective cohort consisted of 106 consecutive patients seen at the clinic from 2007 to 2010. Most were 8 or 9 years old, male (57%), and white (77%), and "most importantly, 26% had a personal history of migraine, which did not occur during the vomiting."

Most of the children (71%) also had a family history of migraine; 10% had a family history of epilepsy.

The episodes occurred an average every 4 weeks. The mean duration of the acute phase was 25 hours, with a mean of 18 vomits during that time, up to 5 per hour. "There was complete resolution of symptoms between the spells in 88% of these children," Dr. Rothner said.

Most children (73%) had a prodromal phase, usually abdominal pain and nausea. There were some identifiable triggers for 66%, including viral illness, and motion sickness. Along with vomiting, 25% of the children had some autonomic symptom, including fever and hypertension.

Of the 42 patients who underwent magnetic resonance imaging, 57% had normal results. "Some of them already had the abnormalities recognized before the disorder began, but none of them had anything to do with the vomiting," Dr. Rothner said.

He and his team also performed abdominal ultrasound on 41 children during the acute phase to rule out intestinal malrotation or volvulus. There were no gastrointestinal abnormalities related to vomiting. Likewise, esophagogastroduodenoscopies in 27 patients showed no serious issues, other than six cases of gastritis.

The investigators aimed to perform metabolic testing of blood and urine during both the well and ill phase in all children. At least some testing was accomplished in 58. One-third of the children tested during the ill or well phase, or during both, showed some sign of mitochondrial dysfunction or abnormal oxidation of fatty acid.

But the results were very difficult to interpret, Dr. Rothner said. "Of the 16 patients who had testing at both phases, 13 had abnormalities. But three showed mitochondrial dysfunction when well and not when ill, four had abnormalities when ill but not when well, and another three had some combination of mitochondrial and fatty acid dysfunction during both times. When we looked at the metabolic testing based on timing, we expected to find more abnormalities at the time of acute illness, but this was not the case. The results were not consistent."

There is no universally accepted treatment for the disorder. "Nothing controls it or makes it go away," Dr. Rothner said. For prophylactic treatment, about half of the group experienced some benefit from amitriptyline. During the acute phase, 85 children tried high-dose oral ondansetron, which improved or resolved symptoms in 66%.

Now, based on the metabolic testing, some of the children in the group also receive carnitine and coenzyme Q10, which Dr. Rothner said confers at least some benefit to about half the group.

The children are part of a continuous study which Dr. Rothner hopes will shed more light on the disorder’s connection with metabolic dysfunction.

He reported having no financial disclosures.

WASHINGTON – About a third of children with cyclic vomiting syndrome appear to have some metabolic condition, either mitochondrial dysfunction, fatty acid oxidation dysfunction, or a combination of both.

Unfortunately, there seems to be neither rhyme nor reason to the pattern. "Some showed the abnormalities only when well, some showed them only when acutely ill, and some showed them all the time," Dr. David Rothner said at the annual meeting of the American Headache Society.

Dr. Rothner, director of the Pediatric/Adolescent Headache Program at the Cleveland Clinic, and his colleagues presented the largest-to-date case series of metabolic testing in children with cyclic vomiting syndrome. Considered one of the three subtypes of migraine, cyclic vomiting is a debilitating illness with no known etiology and virtually no physical abnormalities that account for its occurrence.

The condition is a chronic disorder characterized by repeated, stereotypical vomiting episodes accompanied by severe nausea and sometimes by headache. The four components to the syndrome include: the prodrome, when severe nausea is present; the severe emetic phase; the postemetic phase; and the time between cycles, during which the patient is entirely well.

Most frequently, the vomiting episode begins between 4 and 6 a.m. "During a spell, a child can vomit every 10-15 minutes, for up to 2 days. There is more vomiting with this syndrome than in any other disease known to man."

Diagnosis can only be made by ruling out every possible physical cause. "Often, the time from the first episode until diagnosis can be 3 or 4 years, which is tragic," he said.

The prospective cohort consisted of 106 consecutive patients seen at the clinic from 2007 to 2010. Most were 8 or 9 years old, male (57%), and white (77%), and "most importantly, 26% had a personal history of migraine, which did not occur during the vomiting."

Most of the children (71%) also had a family history of migraine; 10% had a family history of epilepsy.

The episodes occurred an average every 4 weeks. The mean duration of the acute phase was 25 hours, with a mean of 18 vomits during that time, up to 5 per hour. "There was complete resolution of symptoms between the spells in 88% of these children," Dr. Rothner said.

Most children (73%) had a prodromal phase, usually abdominal pain and nausea. There were some identifiable triggers for 66%, including viral illness, and motion sickness. Along with vomiting, 25% of the children had some autonomic symptom, including fever and hypertension.

Of the 42 patients who underwent magnetic resonance imaging, 57% had normal results. "Some of them already had the abnormalities recognized before the disorder began, but none of them had anything to do with the vomiting," Dr. Rothner said.

He and his team also performed abdominal ultrasound on 41 children during the acute phase to rule out intestinal malrotation or volvulus. There were no gastrointestinal abnormalities related to vomiting. Likewise, esophagogastroduodenoscopies in 27 patients showed no serious issues, other than six cases of gastritis.

The investigators aimed to perform metabolic testing of blood and urine during both the well and ill phase in all children. At least some testing was accomplished in 58. One-third of the children tested during the ill or well phase, or during both, showed some sign of mitochondrial dysfunction or abnormal oxidation of fatty acid.

But the results were very difficult to interpret, Dr. Rothner said. "Of the 16 patients who had testing at both phases, 13 had abnormalities. But three showed mitochondrial dysfunction when well and not when ill, four had abnormalities when ill but not when well, and another three had some combination of mitochondrial and fatty acid dysfunction during both times. When we looked at the metabolic testing based on timing, we expected to find more abnormalities at the time of acute illness, but this was not the case. The results were not consistent."

There is no universally accepted treatment for the disorder. "Nothing controls it or makes it go away," Dr. Rothner said. For prophylactic treatment, about half of the group experienced some benefit from amitriptyline. During the acute phase, 85 children tried high-dose oral ondansetron, which improved or resolved symptoms in 66%.

Now, based on the metabolic testing, some of the children in the group also receive carnitine and coenzyme Q10, which Dr. Rothner said confers at least some benefit to about half the group.

The children are part of a continuous study which Dr. Rothner hopes will shed more light on the disorder’s connection with metabolic dysfunction.

He reported having no financial disclosures.

WASHINGTON – About a third of children with cyclic vomiting syndrome appear to have some metabolic condition, either mitochondrial dysfunction, fatty acid oxidation dysfunction, or a combination of both.

Unfortunately, there seems to be neither rhyme nor reason to the pattern. "Some showed the abnormalities only when well, some showed them only when acutely ill, and some showed them all the time," Dr. David Rothner said at the annual meeting of the American Headache Society.

Dr. Rothner, director of the Pediatric/Adolescent Headache Program at the Cleveland Clinic, and his colleagues presented the largest-to-date case series of metabolic testing in children with cyclic vomiting syndrome. Considered one of the three subtypes of migraine, cyclic vomiting is a debilitating illness with no known etiology and virtually no physical abnormalities that account for its occurrence.

The condition is a chronic disorder characterized by repeated, stereotypical vomiting episodes accompanied by severe nausea and sometimes by headache. The four components to the syndrome include: the prodrome, when severe nausea is present; the severe emetic phase; the postemetic phase; and the time between cycles, during which the patient is entirely well.

Most frequently, the vomiting episode begins between 4 and 6 a.m. "During a spell, a child can vomit every 10-15 minutes, for up to 2 days. There is more vomiting with this syndrome than in any other disease known to man."

Diagnosis can only be made by ruling out every possible physical cause. "Often, the time from the first episode until diagnosis can be 3 or 4 years, which is tragic," he said.

The prospective cohort consisted of 106 consecutive patients seen at the clinic from 2007 to 2010. Most were 8 or 9 years old, male (57%), and white (77%), and "most importantly, 26% had a personal history of migraine, which did not occur during the vomiting."

Most of the children (71%) also had a family history of migraine; 10% had a family history of epilepsy.

The episodes occurred an average every 4 weeks. The mean duration of the acute phase was 25 hours, with a mean of 18 vomits during that time, up to 5 per hour. "There was complete resolution of symptoms between the spells in 88% of these children," Dr. Rothner said.

Most children (73%) had a prodromal phase, usually abdominal pain and nausea. There were some identifiable triggers for 66%, including viral illness, and motion sickness. Along with vomiting, 25% of the children had some autonomic symptom, including fever and hypertension.

Of the 42 patients who underwent magnetic resonance imaging, 57% had normal results. "Some of them already had the abnormalities recognized before the disorder began, but none of them had anything to do with the vomiting," Dr. Rothner said.

He and his team also performed abdominal ultrasound on 41 children during the acute phase to rule out intestinal malrotation or volvulus. There were no gastrointestinal abnormalities related to vomiting. Likewise, esophagogastroduodenoscopies in 27 patients showed no serious issues, other than six cases of gastritis.

The investigators aimed to perform metabolic testing of blood and urine during both the well and ill phase in all children. At least some testing was accomplished in 58. One-third of the children tested during the ill or well phase, or during both, showed some sign of mitochondrial dysfunction or abnormal oxidation of fatty acid.

But the results were very difficult to interpret, Dr. Rothner said. "Of the 16 patients who had testing at both phases, 13 had abnormalities. But three showed mitochondrial dysfunction when well and not when ill, four had abnormalities when ill but not when well, and another three had some combination of mitochondrial and fatty acid dysfunction during both times. When we looked at the metabolic testing based on timing, we expected to find more abnormalities at the time of acute illness, but this was not the case. The results were not consistent."

There is no universally accepted treatment for the disorder. "Nothing controls it or makes it go away," Dr. Rothner said. For prophylactic treatment, about half of the group experienced some benefit from amitriptyline. During the acute phase, 85 children tried high-dose oral ondansetron, which improved or resolved symptoms in 66%.

Now, based on the metabolic testing, some of the children in the group also receive carnitine and coenzyme Q10, which Dr. Rothner said confers at least some benefit to about half the group.

The children are part of a continuous study which Dr. Rothner hopes will shed more light on the disorder’s connection with metabolic dysfunction.

He reported having no financial disclosures.

WASHINGTON – About a third of children with cyclic vomiting syndrome appear to have some metabolic condition, either mitochondrial dysfunction, fatty acid oxidation dysfunction, or a combination of both.

Unfortunately, there seems to be neither rhyme nor reason to the pattern. "Some showed the abnormalities only when well, some showed them only when acutely ill, and some showed them all the time," Dr. David Rothner said at the annual meeting of the American Headache Society.

Dr. Rothner, director of the Pediatric/Adolescent Headache Program at the Cleveland Clinic, and his colleagues presented the largest-to-date case series of metabolic testing in children with cyclic vomiting syndrome. Considered one of the three subtypes of migraine, cyclic vomiting is a debilitating illness with no known etiology and virtually no physical abnormalities that account for its occurrence.

The condition is a chronic disorder characterized by repeated, stereotypical vomiting episodes accompanied by severe nausea and sometimes by headache. The four components to the syndrome include: the prodrome, when severe nausea is present; the severe emetic phase; the postemetic phase; and the time between cycles, during which the patient is entirely well.

Most frequently, the vomiting episode begins between 4 and 6 a.m. "During a spell, a child can vomit every 10-15 minutes, for up to 2 days. There is more vomiting with this syndrome than in any other disease known to man."

Diagnosis can only be made by ruling out every possible physical cause. "Often, the time from the first episode until diagnosis can be 3 or 4 years, which is tragic," he said.

The prospective cohort consisted of 106 consecutive patients seen at the clinic from 2007 to 2010. Most were 8 or 9 years old, male (57%), and white (77%), and "most importantly, 26% had a personal history of migraine, which did not occur during the vomiting."

Most of the children (71%) also had a family history of migraine; 10% had a family history of epilepsy.

The episodes occurred an average every 4 weeks. The mean duration of the acute phase was 25 hours, with a mean of 18 vomits during that time, up to 5 per hour. "There was complete resolution of symptoms between the spells in 88% of these children," Dr. Rothner said.

Most children (73%) had a prodromal phase, usually abdominal pain and nausea. There were some identifiable triggers for 66%, including viral illness, and motion sickness. Along with vomiting, 25% of the children had some autonomic symptom, including fever and hypertension.

Of the 42 patients who underwent magnetic resonance imaging, 57% had normal results. "Some of them already had the abnormalities recognized before the disorder began, but none of them had anything to do with the vomiting," Dr. Rothner said.

He and his team also performed abdominal ultrasound on 41 children during the acute phase to rule out intestinal malrotation or volvulus. There were no gastrointestinal abnormalities related to vomiting. Likewise, esophagogastroduodenoscopies in 27 patients showed no serious issues, other than six cases of gastritis.

The investigators aimed to perform metabolic testing of blood and urine during both the well and ill phase in all children. At least some testing was accomplished in 58. One-third of the children tested during the ill or well phase, or during both, showed some sign of mitochondrial dysfunction or abnormal oxidation of fatty acid.

But the results were very difficult to interpret, Dr. Rothner said. "Of the 16 patients who had testing at both phases, 13 had abnormalities. But three showed mitochondrial dysfunction when well and not when ill, four had abnormalities when ill but not when well, and another three had some combination of mitochondrial and fatty acid dysfunction during both times. When we looked at the metabolic testing based on timing, we expected to find more abnormalities at the time of acute illness, but this was not the case. The results were not consistent."

There is no universally accepted treatment for the disorder. "Nothing controls it or makes it go away," Dr. Rothner said. For prophylactic treatment, about half of the group experienced some benefit from amitriptyline. During the acute phase, 85 children tried high-dose oral ondansetron, which improved or resolved symptoms in 66%.

Now, based on the metabolic testing, some of the children in the group also receive carnitine and coenzyme Q10, which Dr. Rothner said confers at least some benefit to about half the group.

The children are part of a continuous study which Dr. Rothner hopes will shed more light on the disorder’s connection with metabolic dysfunction.

He reported having no financial disclosures.

WASHINGTON – The vast majority of headaches in children younger than 8 years old have no dangerous or life-threatening etiology, a retrospective study has shown.

Of 100 children who presented with headache, only 2 had a dangerous condition – brain tumor – and both of those patients also had concerning neurologic symptoms.

The findings should be reassuring not only to parents, but to physicians as well, Dr. Carey Taute said at the annual meeting of the American Headache Society.

"Headache is a very common complaint in the pediatric neurology clinic, emergency department, and pediatric hospital, and everyone is, of course, worried about a dangerous etiology," said Dr. Taute of the Cleveland Clinic. "But in young children, there is a poor ability to get descriptions like the time of onset, duration, location, and nature of pain.

"This can lead to physician uncertainty about how to manage," she added. "Sometimes, this leads to an extensive but unnecessary work-up in these children."

Dr. Taute presented the initial results of 100 patients included in a 300-patient retrospective chart study. The children’s median age was 5 years; gender was evenly split. Most (53%) presented to a pediatric neurology clinic; others presented at a pediatric hospital (27%) and the remainder, to an emergency department.

Of this initial group, nine were excluded from the review because of pre-existing medical conditions, including three with Chiari’s malformation – two of whom had undergone surgical decompression; three with ventriculoperitoneal shunt for hydrocephalus; and three with known brain tumors.

Of the remaining 91 children, 49 were determined to have primary headache. The most common finding was migraine (28), followed by nonclassifiable headache (18), chronic daily headache (2), and one child with tension-type headache.

Secondary headache occurred in 41 of the children. "Of these, the vast majority (37) were attributable to a viral or other illness, but not to any dangerous complications," Dr. Taute said. Physicians couldn’t determine one child’s headache as primary or secondary; that child was referred for brain imaging but did not undergo the test.

A life-threatening cause appeared in only 2 of the 91 children; both of those children had brain tumors. However, both children had concerning neurologic findings. One presented with progressively worse vomiting and falls over a period of a week, and the headache was worse when lying down. The other presented with a head tilt, unilateral increased tone, and unilateral dysmetria.

Overall, primary headache and headache caused by an illness are the most common types of headache in this age group, Dr. Taute said. "Fear of a life-threatening etiology is most often not supported without an abnormal neurologic exam or some concerning neurologic symptoms."

Dr. Taute said she had no relevant financial disclosures.

WASHINGTON – The vast majority of headaches in children younger than 8 years old have no dangerous or life-threatening etiology, a retrospective study has shown.

Of 100 children who presented with headache, only 2 had a dangerous condition – brain tumor – and both of those patients also had concerning neurologic symptoms.

The findings should be reassuring not only to parents, but to physicians as well, Dr. Carey Taute said at the annual meeting of the American Headache Society.

"Headache is a very common complaint in the pediatric neurology clinic, emergency department, and pediatric hospital, and everyone is, of course, worried about a dangerous etiology," said Dr. Taute of the Cleveland Clinic. "But in young children, there is a poor ability to get descriptions like the time of onset, duration, location, and nature of pain.

"This can lead to physician uncertainty about how to manage," she added. "Sometimes, this leads to an extensive but unnecessary work-up in these children."

Dr. Taute presented the initial results of 100 patients included in a 300-patient retrospective chart study. The children’s median age was 5 years; gender was evenly split. Most (53%) presented to a pediatric neurology clinic; others presented at a pediatric hospital (27%) and the remainder, to an emergency department.

Of this initial group, nine were excluded from the review because of pre-existing medical conditions, including three with Chiari’s malformation – two of whom had undergone surgical decompression; three with ventriculoperitoneal shunt for hydrocephalus; and three with known brain tumors.

Of the remaining 91 children, 49 were determined to have primary headache. The most common finding was migraine (28), followed by nonclassifiable headache (18), chronic daily headache (2), and one child with tension-type headache.

Secondary headache occurred in 41 of the children. "Of these, the vast majority (37) were attributable to a viral or other illness, but not to any dangerous complications," Dr. Taute said. Physicians couldn’t determine one child’s headache as primary or secondary; that child was referred for brain imaging but did not undergo the test.

A life-threatening cause appeared in only 2 of the 91 children; both of those children had brain tumors. However, both children had concerning neurologic findings. One presented with progressively worse vomiting and falls over a period of a week, and the headache was worse when lying down. The other presented with a head tilt, unilateral increased tone, and unilateral dysmetria.

Overall, primary headache and headache caused by an illness are the most common types of headache in this age group, Dr. Taute said. "Fear of a life-threatening etiology is most often not supported without an abnormal neurologic exam or some concerning neurologic symptoms."

Dr. Taute said she had no relevant financial disclosures.

WASHINGTON – The vast majority of headaches in children younger than 8 years old have no dangerous or life-threatening etiology, a retrospective study has shown.

Of 100 children who presented with headache, only 2 had a dangerous condition – brain tumor – and both of those patients also had concerning neurologic symptoms.

The findings should be reassuring not only to parents, but to physicians as well, Dr. Carey Taute said at the annual meeting of the American Headache Society.

"Headache is a very common complaint in the pediatric neurology clinic, emergency department, and pediatric hospital, and everyone is, of course, worried about a dangerous etiology," said Dr. Taute of the Cleveland Clinic. "But in young children, there is a poor ability to get descriptions like the time of onset, duration, location, and nature of pain.

"This can lead to physician uncertainty about how to manage," she added. "Sometimes, this leads to an extensive but unnecessary work-up in these children."

Dr. Taute presented the initial results of 100 patients included in a 300-patient retrospective chart study. The children’s median age was 5 years; gender was evenly split. Most (53%) presented to a pediatric neurology clinic; others presented at a pediatric hospital (27%) and the remainder, to an emergency department.

Of this initial group, nine were excluded from the review because of pre-existing medical conditions, including three with Chiari’s malformation – two of whom had undergone surgical decompression; three with ventriculoperitoneal shunt for hydrocephalus; and three with known brain tumors.

Of the remaining 91 children, 49 were determined to have primary headache. The most common finding was migraine (28), followed by nonclassifiable headache (18), chronic daily headache (2), and one child with tension-type headache.

Secondary headache occurred in 41 of the children. "Of these, the vast majority (37) were attributable to a viral or other illness, but not to any dangerous complications," Dr. Taute said. Physicians couldn’t determine one child’s headache as primary or secondary; that child was referred for brain imaging but did not undergo the test.

A life-threatening cause appeared in only 2 of the 91 children; both of those children had brain tumors. However, both children had concerning neurologic findings. One presented with progressively worse vomiting and falls over a period of a week, and the headache was worse when lying down. The other presented with a head tilt, unilateral increased tone, and unilateral dysmetria.

Overall, primary headache and headache caused by an illness are the most common types of headache in this age group, Dr. Taute said. "Fear of a life-threatening etiology is most often not supported without an abnormal neurologic exam or some concerning neurologic symptoms."

Dr. Taute said she had no relevant financial disclosures.

WASHINGTON – The vast majority of headaches in children younger than 8 years old have no dangerous or life-threatening etiology, a retrospective study has shown.

Of 100 children who presented with headache, only 2 had a dangerous condition – brain tumor – and both of those patients also had concerning neurologic symptoms.

The findings should be reassuring not only to parents, but to physicians as well, Dr. Carey Taute said at the annual meeting of the American Headache Society.

"Headache is a very common complaint in the pediatric neurology clinic, emergency department, and pediatric hospital, and everyone is, of course, worried about a dangerous etiology," said Dr. Taute of the Cleveland Clinic. "But in young children, there is a poor ability to get descriptions like the time of onset, duration, location, and nature of pain.

"This can lead to physician uncertainty about how to manage," she added. "Sometimes, this leads to an extensive but unnecessary work-up in these children."

Dr. Taute presented the initial results of 100 patients included in a 300-patient retrospective chart study. The children’s median age was 5 years; gender was evenly split. Most (53%) presented to a pediatric neurology clinic; others presented at a pediatric hospital (27%) and the remainder, to an emergency department.

Of this initial group, nine were excluded from the review because of pre-existing medical conditions, including three with Chiari’s malformation – two of whom had undergone surgical decompression; three with ventriculoperitoneal shunt for hydrocephalus; and three with known brain tumors.

Of the remaining 91 children, 49 were determined to have primary headache. The most common finding was migraine (28), followed by nonclassifiable headache (18), chronic daily headache (2), and one child with tension-type headache.

Secondary headache occurred in 41 of the children. "Of these, the vast majority (37) were attributable to a viral or other illness, but not to any dangerous complications," Dr. Taute said. Physicians couldn’t determine one child’s headache as primary or secondary; that child was referred for brain imaging but did not undergo the test.

A life-threatening cause appeared in only 2 of the 91 children; both of those children had brain tumors. However, both children had concerning neurologic findings. One presented with progressively worse vomiting and falls over a period of a week, and the headache was worse when lying down. The other presented with a head tilt, unilateral increased tone, and unilateral dysmetria.

Overall, primary headache and headache caused by an illness are the most common types of headache in this age group, Dr. Taute said. "Fear of a life-threatening etiology is most often not supported without an abnormal neurologic exam or some concerning neurologic symptoms."

Dr. Taute said she had no relevant financial disclosures.

WASHINGTON – The vast majority of headaches in children younger than 8 years old have no dangerous or life-threatening etiology, a retrospective study has shown.

Of 100 children who presented with headache, only 2 had a dangerous condition – brain tumor – and both of those patients also had concerning neurologic symptoms.

The findings should be reassuring not only to parents, but to physicians as well, Dr. Carey Taute said at the annual meeting of the American Headache Society.

"Headache is a very common complaint in the pediatric neurology clinic, emergency department, and pediatric hospital, and everyone is, of course, worried about a dangerous etiology," said Dr. Taute of the Cleveland Clinic. "But in young children, there is a poor ability to get descriptions like the time of onset, duration, location, and nature of pain.

"This can lead to physician uncertainty about how to manage," she added. "Sometimes, this leads to an extensive but unnecessary work-up in these children."

Dr. Taute presented the initial results of 100 patients included in a 300-patient retrospective chart study. The children’s median age was 5 years; gender was evenly split. Most (53%) presented to a pediatric neurology clinic; others presented at a pediatric hospital (27%) and the remainder, to an emergency department.

Of this initial group, nine were excluded from the review because of pre-existing medical conditions, including three with Chiari’s malformation – two of whom had undergone surgical decompression; three with ventriculoperitoneal shunt for hydrocephalus; and three with known brain tumors.

Of the remaining 91 children, 49 were determined to have primary headache. The most common finding was migraine (28), followed by nonclassifiable headache (18), chronic daily headache (2), and one child with tension-type headache.

Secondary headache occurred in 41 of the children. "Of these, the vast majority (37) were attributable to a viral or other illness, but not to any dangerous complications," Dr. Taute said. Physicians couldn’t determine one child’s headache as primary or secondary; that child was referred for brain imaging but did not undergo the test.

A life-threatening cause appeared in only 2 of the 91 children; both of those children had brain tumors. However, both children had concerning neurologic findings. One presented with progressively worse vomiting and falls over a period of a week, and the headache was worse when lying down. The other presented with a head tilt, unilateral increased tone, and unilateral dysmetria.

Overall, primary headache and headache caused by an illness are the most common types of headache in this age group, Dr. Taute said. "Fear of a life-threatening etiology is most often not supported without an abnormal neurologic exam or some concerning neurologic symptoms."

Dr. Taute said she had no relevant financial disclosures.

WASHINGTON – The vast majority of headaches in children younger than 8 years old have no dangerous or life-threatening etiology, a retrospective study has shown.

Of 100 children who presented with headache, only 2 had a dangerous condition – brain tumor – and both of those patients also had concerning neurologic symptoms.

The findings should be reassuring not only to parents, but to physicians as well, Dr. Carey Taute said at the annual meeting of the American Headache Society.

"Headache is a very common complaint in the pediatric neurology clinic, emergency department, and pediatric hospital, and everyone is, of course, worried about a dangerous etiology," said Dr. Taute of the Cleveland Clinic. "But in young children, there is a poor ability to get descriptions like the time of onset, duration, location, and nature of pain.

"This can lead to physician uncertainty about how to manage," she added. "Sometimes, this leads to an extensive but unnecessary work-up in these children."

Dr. Taute presented the initial results of 100 patients included in a 300-patient retrospective chart study. The children’s median age was 5 years; gender was evenly split. Most (53%) presented to a pediatric neurology clinic; others presented at a pediatric hospital (27%) and the remainder, to an emergency department.

Of this initial group, nine were excluded from the review because of pre-existing medical conditions, including three with Chiari’s malformation – two of whom had undergone surgical decompression; three with ventriculoperitoneal shunt for hydrocephalus; and three with known brain tumors.

Of the remaining 91 children, 49 were determined to have primary headache. The most common finding was migraine (28), followed by nonclassifiable headache (18), chronic daily headache (2), and one child with tension-type headache.

Secondary headache occurred in 41 of the children. "Of these, the vast majority (37) were attributable to a viral or other illness, but not to any dangerous complications," Dr. Taute said. Physicians couldn’t determine one child’s headache as primary or secondary; that child was referred for brain imaging but did not undergo the test.

A life-threatening cause appeared in only 2 of the 91 children; both of those children had brain tumors. However, both children had concerning neurologic findings. One presented with progressively worse vomiting and falls over a period of a week, and the headache was worse when lying down. The other presented with a head tilt, unilateral increased tone, and unilateral dysmetria.

Overall, primary headache and headache caused by an illness are the most common types of headache in this age group, Dr. Taute said. "Fear of a life-threatening etiology is most often not supported without an abnormal neurologic exam or some concerning neurologic symptoms."

Dr. Taute said she had no relevant financial disclosures.