Pediatric Headache Research Articles

Headache after pediatric traumatic brain injury: a comparison between a post-acute sample of children and adolescents and general population

BackgroundHeadache is one of the most common post-concussion symptoms following pediatric traumatic brain injury (TBI). To better understand its impact on young individuals, this study aims to investigate the prevalence of headache in a German-speaking post-acute pediatric TBI sample and compare it with the general population. In addition, factors associated with the development of pediatric post-TBI headache are investigated to improve the understanding of this condition.MethodsA post-acute sample (3 months up to 10 years post-injury) comprising N = 463 children and adolescents aged 8 to 17 years from the TBI sample and N = 463 individuals from the general population matched for gender, age, and health status were included in the study. The Postconcussion Symptom Inventory (PCSI) item assessing headache was used as the outcome variable. Logistic regression was used to examine the association between the risk of developing headache and sociodemographic and health-related factors.ResultsSlightly less than half of the participants reported the presence of headache (TBI sample: 46%; matched controls: 44%). Compared with matched controls, the odds of headache in the TBI sample were not significantly different (OR = 1.09, 95% CI 0.85 to 1.4, p = 0.49). The association between PCSI symptoms was generally stronger in adolescents than in children and in the matched controls than in the TBI sample. In the TBI sample, the probability of reporting headache increased with age.ConclusionsThe results of this study suggest that the prevalence of headache in the post-acute phase of pediatric TBI is not significantly different from that in the matched non-TBI population, indicating good recovery from injury. However, due to its high prevalence, follow-up screening for this common TBI symptom, especially in adolescents, may be helpful to prevent further chronification.Trial registrationThe study is retrospectively registered in German Clinical Trials Register and in International Clinical Trials Registry Platform (ID DRKS00032854).

Retrospective Study of the Efficacy of Biofeedback Therapy for Pediatric Persistent Posttraumatic Headache.

Posttraumatic headache is common in pediatrics. Studies have examined treatment of postconcussion symptoms, but few target posttraumatic headache. Biofeedback therapy has been studied in children and teens with primary headaches, but not posttraumatic headache. Our goal was to examine the changes in posttraumatic headache associated with biofeedback therapy in pediatric patients. This retrospective study included 74 children aged 10-18 years who received biofeedback therapy for posttraumatic headache. "Positive response" to biofeedback therapy was defined as ≥50% reduction in headache days per week, or 3-point drop in pain rating between the first and last biofeedback therapy visits. Patient characteristics were analyzed using logistic regression to identify factors associated with response. In our cohort, 42% of all patients with posttraumatic headache had a positive response to biofeedback therapy. Thirty-six percent experienced ≥50% decrease in headache frequency, 13% had a ≥3-point decrease in headache severity and 8% reported both changes. For those with daily headaches, 36% had a positive response to biofeedback therapy. School absences, selective serotonin reuptake inhibitor or prescription preventive medication use were associated with nonresponse. Biofeedback therapy is a reasonable treatment to consider to manage pediatric posttraumatic headache because more than 40% of our cohort had a beneficial response and biofeedback therapy has few adverse effects.

Evaluation of pediatric migraine triggers: a single-center study.

Pediatric migraines are primarily treated with medications. However, recognizing the triggers related to patient behaviors and lifestyle is also important. This study aimed to evaluate the factors that trigger pediatric migraines. This study included 102 pediatric patients with migraine diagnosed using the third edition of the International Classification of Headache Disorders who visited our pediatric headache clinic between November 2021 and October 2022. We reviewed the patients' clinical features, imaging studies, screening tests for behaviors and emotions, and questionnaires regarding triggers. Statistical analyses were performed using the independent sample Student's t-test and linear-by-linear association test. The 102 patients (44 male, 58 female; mean age, 12.0 ± 2.9 years) were classified into migraine without aura (n = 58) and migraine with aura (n = 44) groups. Sleep disturbances were the most frequent trigger (76.5%). Other triggers included academic stress (66.7%), motion sickness (62.7%), and fatigue (52.9%). Academic stress was the most significant trigger for pain severity in 44.1% of patients. Abnormal behavioral or psychiatric assessment results were associated with a higher number of triggers. This study identified sleep disturbance and academic stress as common triggers of pediatric migraine, with academic stress being the most intense. Clinicians should understand these triggers and advise patients to avoid them by changing their lifestyles, if possible.

Enhancing Clinical History Taking Through the Implementation of a Streamlined Electronic Questionnaire System at a Pediatric Headache Clinic: Development and Evaluation Study.

Accurate history taking is essential for diagnosis, treatment, and patient care, yet miscommunications and time constraints often lead to incomplete information. Consequently, there has been a pressing need to establish a system whereby the questionnaire is duly completed before the medical appointment, entered into the electronic health record (EHR), and stored in a structured format within a database. This study aimed to develop and evaluate a streamlined electronic questionnaire system, BEST-Survey (Bundang Hospital Electronic System for Total Care-Survey), integrated with the EHR, to enhance history taking and data management for patients with pediatric headaches. An electronic questionnaire system was developed at Seoul National University Bundang Hospital, allowing patients to complete previsit questionnaires on a tablet PC. The information is automatically integrated into the EHR and stored in a structured database for further analysis. A retrospective analysis compared clinical information acquired from patients aged <18 years visiting the pediatric neurology outpatient clinic for headaches, before and after implementing the BEST-Survey system. The study included 365 patients before and 452 patients after system implementation. Answer rates and positive rates of key headache characteristics were compared between the 2 groups to evaluate the system's clinical utility. Implementation of the BEST-Survey system significantly increased the mean data acquisition rate from 54.6% to 99.3% (P<.001). Essential clinical features such as onset, location, duration, severity, nature, and frequency were obtained in over 98.7% (>446/452) of patients after implementation, compared to from 53.7% (196/365) to 85.2% (311/365) before. The electronic system facilitated comprehensive data collection, enabling detailed analysis of headache characteristics in the patient population. Most patients (280/452, 61.9%) reported headache onset less than 1 year prior, with the temporal region being the most common pain location (261/703, 37.1%). Over half (232/452, 51.3%) experienced headaches lasting less than 2 hours, with nausea and vomiting as the most commonly associated symptoms (231/1036, 22.3%). The BEST-Survey system markedly improved the completeness and accuracy of essential history items for patients with pediatric headaches. The system also streamlined data extraction and analysis for clinical and research purposes. While the electronic questionnaire cannot replace physician-led history taking, it serves as a valuable adjunctive tool to enhance patient care.

The Photo- and Phonosensitivity Avoidance Behavior Scales: Evaluating Clinical Utility in Pediatric Primary Chronic Headache.

Background/Objectives: Pediatric primary chronic headache disorders are often associated with sensitivities to light (photosensitivity) and sound (phonosensitivity) that may trigger or worsen headache pain. These sensory sensitivities may result in changes to activity participation or environmental modifications to avoid visual and auditory stimuli. Over time, avoidance behaviors can inadvertently increase functional disability, suggesting the importance of their thorough consideration. The PhotoSensitivity and PhonoSensitivity Avoidance Behavior Scales (PHOTO-SABS and PHONO-SABS, respectively) were recently developed and preliminarily validated to assist clinicians in evaluating such behaviors. This study aimed to confirm each of their factor structures in a new sample and enhance their clinical utility. Methods: A sample of 176 youth (aged 8-17) with a primary chronic headache diagnosis completed the PHOTO-SABS and PHONO-SABS as part of their multidisciplinary evaluation in a pediatric headache clinic. Results: Consistent with the previous validation, confirmatory factor analyses supported a two-factor model for the PHOTO-SABS and a single-factor model for the PHONO-SABS. Tertile groupings (low, moderate, high) provided the most appropriate clinical reference points. The relative change criterion (RCCrit) was established at 6.4 points for both measures. Conclusions: These findings confirm that the PHOTO- and PHONO-SABS are psychometrically robust tools for clinicians to evaluate sensitivity-related avoidance behavior and to monitor response to interventions in youth with primary chronic headaches.

Special Issue: “A Wider Look at Pediatric Primary Headaches”

Headaches represent a common and debilitating neurological disorder among the pediatric population [...]

Internalizing disorders rather than ADHD are risk factors for chronicity in pediatric migraine patients.

Migraine is a prevalent neurological disorder that can lead to disability in children and adolescents. It is frequently accompanied by psychiatric comorbidities, both internalizing and externalizing disorders. While the relationship between migraine and internalizing disorders has been studied, there is limited research on the link between migraine and attention deficit hyperactivity disorder (ADHD). A total of 280 pediatric headache patients, 107 with externalizing (ADHD) and 173 with internalizing disorders (depression and/or anxiety), were included. The dataset was composed using the Turkish headache database, Mersin Branch. Pain characteristics, associated symptoms, and accompanying comorbidities were evaluated retrospectively. Two hundred four patients were followed up with episodic migraine (EM) and 76 patients with chronic migraine (CM). One hundred forty-six boys and 134 girls were evaluated, and internalizing disorders were more common in the girls (p < 0.001). It was a much more prominent accompaniment in chronic migraine internalizing disorders (p = 0.038). EM, on the other hand, was more frequent in ADHD. Pain intensity and frequency were greater in those with internalizing disorders (p = 0.007), while photophobia was more prevalent in those with ADHD (OR; 0.555, p = 0.044). Moreover, we observed that individuals with internalizing disorders were predominantly female (p = 0.003) and had a higher mean age (p < 0.001) than those with externalizing disorders. Internalizing disorders seem to be a risk factor for migraine chronification in pediatric migraine. ADHD is a prototypic externalizing disorder more associated with EM. This outcome provides an opportunity to follow our patients in terms of prognosis and offers us the chance for a better evaluation. Identifying factors that contribute to the chronicity of migraine may lead to better management and reduced disability for migraine sufferers.

Pediatric Headache Patients Are at High Risk of Vitamin D Insufficiency.

Vitamin D deficiency has been associated with headaches in adults, but data for children with headaches are sparse. To describe vitamin D levels in children with headaches. We retrospectively analyzed serum 25(OH)D concentrations in children aged 2-17 years with headaches compared to children with epilepsy at the Children's Hospital of Eastern Ontario between October 1, 2014, and August 19, 2021. Serum 25(OH)D <50 nmol/L was classified as insufficient. Vitamin D concentrations of 353 children (117 with headaches; 236 with epilepsy) were analyzed. The median age in years was 10 (interquartile range [IQR] 5, 14); 50.4% of subjects were female. The median serum 25(OH)D was 56 nmol/L (IQR 41, 69) in children with headaches and 70 nmol/L (IQR 50, 95) in children with epilepsy. Vitamin D insufficiency was present in 42% of children with headaches and 25% of children with epilepsy (P = .002). In a multivariable linear regression model adjusting for age, sex and seasonality, children with headaches had serum 25(OH)D concentrations that were on average 9 nmol/L (95% CI-16.76, -0.96) lower compared to children with epilepsy (P = .029). The prevalence of vitamin D insufficiency is higher in children with headaches compared to children with epilepsy. Prospective studies are needed to assess if vitamin D supplementation may have a therapeutic effect on pediatric headaches.

Advancements in pediatric headache.

To provide an update on advancements in pediatric headache. The symptomatology associated with primary headache disorders has been compared with ICHD-3 criteria. Primary stabbing headache pain lasts longer than 3 seconds in over half of patients. Persistent posttraumatic headache or new daily persistent headache have significant overlap in pain character and nonpain-related symptoms with migraine. In a large cohort with continuous headache at first follow-up, 47% reported resolution of their continuous headache and 19.4% had a 50% or greater reduction in frequency with improvements in fluid intake, sleep, not skipping meals, and exercise. There was no correlation with improved lifestyle habits and clinical outcomes despite the overall improvement. Studies noted significant improvement in headache scores with onabotulinum toxin A and incobotulinum toxin A injections with limited side effects. Intranasal sumatriptan without concurrent intravenous therapies found a clinically meaningful decrease in pain score prior to discharge with shorter lengths of stay and lower emergency department costs compared with the those who received intravenous therapies. Newer studies have suggested changes to symptomatology and duration of pediatric headache syndromes. Onabotulinum toxin A and incobotulinum toxin A injections, and emergency department intranasal sumatriptan are well tolerated therapies in pediatric headache.

Headache trajectories in children and adolescents with new onset continuous headache.

New daily persistent headache (NDPH) is a challenging and understudied primary headache disorder with no known effective treatment. Although the International Classification of Headache Disorders criteria require that the new onset continuous headache be present for at least three months before diagnosing NDPH, the biologic basis for when a new, continuous headache starts to behave as NDPH is unknown, and some pediatric headache experts consider that the minimum duration criterion could be shorter. In this retrospective study, we reviewed the intake questionnaires and medical records of 5-17 year-olds seen in neurology clinic for headache at the Children's Hospital of Philadelphia. Those with a new onset continuous headache of at least one month in duration were eligible. The patient's self-report and clinician's description both had to indicate that the headache was new, of abrupt onset, and continuous to be included, although patients were allowed to have a prior history of infrequent headaches. We compared headache outcomes at last follow-up and at one year after continuous headache onset between those who had a continuous headache duration of 1 to <3 months ("new onset headache", or NOH) at first visit vs. those with ≥3 months (NDPH). We used multivariate regression modeling to examine for predictors of headache outcomes. Of 472 patient records reviewed, 172 met the inclusion criteria for analysis. Of these, 84 had a headache duration of 1 to <3 months in duration and 88 had a duration of ≥3 months. Those with shorter duration continuous headache were younger (median (interquartile range) 13.5 (11.1-15.7) vs. 15.1 (12.3-16.5) years, and less likely to have previously received a prescription preventive for the continuous headache (n = 14 (17%) vs. 26 (30%), p = 0.046), but were otherwise similar to those with NDPH in terms of baseline clinical and demographic variables. Sixty-five (74%) of those with NDPH and 60 (71%) with NOH had follow-up data. At last clinic follow-up, 41/65 (63%) with NDPH and 43/60 (72%) with NOH had experienced any headache benefit (p = 0.307), although 39/65 (60%) with NDPH and 29/60 (48%) with NOH still had continuous headache (p = 0.191). Headache duration was not associated with outcomes in multivariate regression modeling. Headache outcomes of children and adolescents with new onset continuous headache, whether of 1 to <3 months (NOH) or ≥3 months in duration (NDPH) are suboptimal. More research is needed to improve treatment outcomes for this patient population.

Ketorolac Dose Ceiling Effect for Pediatric Headache in the Emergency Department

OBJECTIVE This study sought to demonstrate a non-inferiority analgesic ceiling effect previously ­demonstrated within adults for pediatric patients receiving a maximum ketorolac dose of 15 mg. METHODS We conducted a retrospective cohort study of pediatric ED patients weighing at least 60 kg treated with 30 mg (pre-intervention) or 15 mg (post-intervention) intravenous (IV) ketorolac for headache. The primary outcome included patient-reported pain scores. Additional outcomes included demographic variables, adjunct medication use and adverse effects. Categorical data were evaluated using a χ2 test, and numerical data were evaluated using an ANOVA F test and Welch 2-sample t test. RESULTS The pre- and post-intervention groups included 216 and 62 patients, respectively. Overall demographics were similar between the groups (72.3% female, 49.3% White/Caucasian, mean age 15.5 years, mean weight 79.2 kg, and mean baseline 10-point pain score 7.5). Twelve (5.6%) in the pre-intervention group required rescue analgesic compared with 2 patients (3.2%) in the post-intervention group (p = 0.416). In the pre-intervention group, 198 patients (91.7%) received nausea medication compared with 52 patients (83.9%) in the post-intervention group (p = 0.087). Mean 10-point pain scores following ketorolac administration decreased by 3.9 in the pre-intervention group compared with 5.1 in the post-intervention group (p = &amp;lt; 0.001). Common (0.9%) or rare (0.9%) side effects were infrequent and only seen in the pre-intervention group patients. CONCLUSIONS Truncating the maximum intravenous ketorolac dose in pediatric patients at least 60 kg in weight to 15 mg compared with 30 mg results in effective analgesia in pediatric patients with headache. Future research could explore differences in admission rates, treatment of other indications, or treatment with multiple-dose regimens.

Headaches in Pediatric Patients during the Past Decade: Comparative Analysis by Age Group from a Multicenter Study in Korea.

Headache is a common complaint during childhood and adolescence. It is important to be aware of the characteristics of pediatric headaches in order to make a precise and timely diagnosis. This study investigated the clinical characteristics of pediatric headaches according to the underlying etiology and age group. We retrospectively reviewed the medical records of 3374 pediatric patients (2667 with primary headache [PH] and 707 with secondary headache [SH]) who presented with headaches at two centers between January 2012 and November 2023. The incidence of PH was significantly higher in adolescents (40.1% vs. 22.9%), whereas that of SH was considerably higher in preschoolers (37.5% vs. 16.3%) (p < 0.001). The prevalence of headaches attributed to infection was significantly higher in preschool and school-aged children (90.8% vs. 80.2%, p < 0.001); adolescents exhibited significantly higher frequencies of cranial and cervical vascular disorders (3.7% vs. 1.3%, p = 0.044) and psychiatric disorders (5.6% vs. 0.6%, p < 0.001). Statistically significant differences were observed between preschool/school-aged children and adolescents in terms of headache characteristics and the prevalence of headache-associated symptoms (60.4% vs. 74.1%, p < 0.001 in PH), neurologic abnormalities (10.2% vs. 23.6%, p < 0.001 in PH; 2.4% vs. 11.7%, p < 0.001 in SH), and headache triggers (19.9% vs. 24.2%, p = 0.008 in PH; 2.0% vs. 8.0%, p < 0.001 in SH). Recognizing the etiology and age-specific differences in the clinical characteristics of headaches is crucial for an accurate and timely diagnosis. Tailoring the diagnostic approach accordingly helps to achieve optimal outcomes in pediatric patients with headaches.

Nonpharmacologic Treatment Options in Pediatric Tension-Type Headache Patients: A Systematic Review.

Objective: This systematic review aims to examine effects of nonpharmacologic treatment options for pediatric tension-type headache patients as well as evaluate current results from these treatment options. Background: Headache is a worldwide problem among both adults and children, with tension-type headache among the most common. Methods: Eighteen relevant studies were found using PubMed and evaluated in this review. These include therapy programs, biofeedback, alternative medicine, strength exercise, physical therapy, mindfulness therapy, and psychotherapy. Results: Several nonpharmacologic treatment methods showed improvement in pediatric headache patients, with few reported adverse effects. This suggests that nonpharmacologic treatment is safe for use and might have an effect in most cases. Conclusion: No single intervention has been proven superior to another, and some studies would need replication with a control group to confirm the findings. This study illustrates the variety of nonpharmacologic treatment options and the importance of future research on this topic.

Effectiveness and Tolerability of Anti-Calcitonin Gene-Related Peptide Therapy for Migraine and Other Chronic Headaches in Adolescents and Young Adults: A Retrospective Study in the USA.

This retrospective study assesses the efficacy and tolerability of anti-calcitonin gene-related peptide (anti-CGRP) therapy in adolescents and young adults (ages 12-21) with migraine and chronic daily headaches unresponsive to standard treatments. Migraines in this demographic significantly impair school performance, self-esteem, psychological well-being, and cognitive health. These young patients are also particularly sensitive to the side effects of conventional medications, which are often prescribed off-label and come with high insurance denial rates. Medication overuse, including analgesics, triptans, and NSAIDs, is prevalent due to treatment failures. Elevated plasma CGRP levels observed during migraines suggest that anti-CGRP therapies, successful in adult populations, may also benefit this younger age group. Over a three-year period, patients at a specialized pediatric headache center were evaluated for the impact of anti-CGRP treatments, including monoclonal antibodies (erenumab, fremanezumab, and galcanezumab) and small-molecule CGRP receptor antagonists (ubrogepant, rimegepant, and atogepant), administered either alone or in combination with OnabotulinumtoxinA. Data were extracted from the hospital's electronic medical records, and patient progress was consistently documented using a structured template for each clinic visit. Additional patient satisfaction data were collected via telephone follow-ups and patient message reviews. The study included 23 patients, primarily treated for chronic migraine (CM) (78.3%), with a smaller subset addressing episodic migraine (EM), new daily persistent headaches (NDPHs), and post-traumatic headaches (PTHs). Comprehensive demographic and clinical data, including age, treatment duration, history of preventive treatment failures, and comorbidities like psychiatric conditions and sleep disorders, were collected. Anti-CGRP therapies, particularly when combined with traditional treatments or OnabotulinumtoxinA, resulted in significant improvements: 91.3% of patients experienced reduced migraine duration and intensity, 82.6% reported improvements in other bothersome symptoms, and 73.9% saw an improved response to rescue medications. Additionally, 78.3% of patients reported a reduction in their use of rescue medications per week by more than 50%, and emergency room visits were reduced for 56.5% of patients. Significant reductions in headache days were observed in 82.6% of patients after one month and 87% after three months, with nearly 40% experiencing more than a 50% reduction in both periods. The greatest benefits were observed in patients treated for more than six months. Adverse effects were minimal, with 95.7% of patients reporting no side effects, and patient satisfaction was high, with 69.6% opting to continue treatment. Overall, this study highlights the substantial potential of anti-CGRP therapy in improving outcomes for adolescents and young adults with CM and EM, offering a promising approach for a demographic that faces considerable challenges with conventional treatment options. However, further research is needed to confirm these findings and expand clinical applications in this age group.

Sex and age-related patterns in pediatric primary headaches: observations from an outpatient headache clinic.

Age reportedly affects headache prevalence differently in boys and girls. However, little empirical data exists regarding pediatric headache prevalence and headache-related burden in children and adolescents according to age and sex. In the present study, we considered age and sex while evaluating the distribution, characteristics, and impairment of primary headache disorders at a pediatric headache center in Germany. Medical records of children and adolescents attending the headache clinic of the Interdisciplinary Pain Center of the Carl Gustav Carus University Hospital in Dresden during the period 2015-2022 were retrospectively grouped and analyzed depending on age (< or ≥14 years) and sex. The study population consisted of 652 children and adolescents, aged between 3 and 18 years. Almost two-thirds of the patients (≈60%) were females, and almost two-thirds of these females (58%) were ≥14 years of age. Generally, the most prevalent headache diagnoses as defined by the International Classification of Headache Disorders 3rd edition were episodic migraine without aura and the combination of tension-type headache and episodic migraine with or without aura i.e., mixed-type headache (each ≈27%). In the younger group (<14 years), the mixed-type headache was the most prevalent in girls (28.6%), whereas, for boys, episodic migraine without aura was the most prevalent headache diagnosis (47.4%). In the older group (≥14 years), the mixed-type headache continued to be the most prevalent for girls (30%), and it became the most prevalent for boys (26.3%). Before the age of 14, about 16% of children were severely affected by their headaches. After the age of 14, this proportion increased to roughly one-third (33%) of adolescents, driven mainly by teenage girls (26%) who were severely affected by their headaches. Furthermore, the prevalence of comorbidities was significantly higher among girls (67%), particularly in the adolescent group (74%). Our data shows that headache disorders in a specialized pediatric clinic impose a significant burden, especially among teenage girls indicating high therapy needs. Enhancing awareness of early diagnosis and preventive care is crucial to mitigate the development of chronic headaches, and mitigate their adverse effects on life quality and educational capability.

Photo- and Phonosensitivity in Pediatric Headache: Assessing the Clinical Utility of Avoidance Behavior Scales

Abstract Date Presented 03/22/24 To improve clinical utilization, this study further examined the psychometric properties of two newly developed and validated measures of photo- and phonosensitivity-related avoidance behaviors in youth ages 8-18 with chronic headache. Primary Author and Speaker: Megan Silvia Contributing Authors: Allison Smith

Evaluating patient and family preferences for acute and preventive pediatric headache treatment.

To describe acute and preventive treatment preferences among youth with migraine and their parents/guardians, and to describe the degree of youth-parent/guardian preference agreement. Headache disorders are common in youth, but little is known about patient and family preferences for headache treatments and outcomes. In this cross-sectional survey, a headache treatment preferences questionnaire was co-created with stakeholders, piloted, and distributed to consenting youth with migraine aged 9-18 years and parents/guardians at a tertiary care headache clinic in western Canada. Response data were summarized for youth and parents/guardians separately, and agreement rates within a youth-parent/guardian pair were compared to a hypothesized agreement rate of 80% for the primary questionnaire items. Seventy-two youth and n = 94 parents/guardians participated, with n = 63 in youth-parent/guardian pairs. Freedom from pain and rapid relief, and reducing pain severity and headache frequency were top acute and preventive treatment priorities, respectively. More than 90% (69/72) agreed that ≥ 50% reduction in headache frequency was a good target. For both acute and preventive interventions, swallowed pill-based options were most often selected as the preferred first-line treatment, with neuromodulation selected as the preferred second-line treatment. The level of agreement within youth-parent/guardian pairs on preferred treatment modalities was lower than hypothesized for acute (63% [40/63], 95% confidence interval [CI] = 52-75%, χ2 = 10.73, p = 0.001) but not for preventive treatment (73% [46/63], 95% CI = 62-84%, χ2 = 1.92, p = 0.166). Regarding which treatment modalities were perceived as most effective, youth-parent agreement was lower than hypothesized for both acute (48% [30/63], 95% CI = 35-60%, χ2 = 41.29, p < 0.001) and preventive treatment (46% [29/63], 95% CI = 34-58%, χ2 = 45.43, p < 0.001). Youth and family preferences aligned qualitatively, but sometimes diverged quantitatively, from typical clinical trial outcomes. The level of agreement within youth-parent/guardian pairs on treatment preferences and perceptions was low. Clinicians should consider both perspectives as they may be divergent.

Impact of virtual reality-delivered biofeedback and yoga on pediatric headaches: A pilot study.

Impact of virtual reality-delivered biofeedback and yoga on pediatric headaches: A pilot study.

P.044 Ambient air pollution and emergency department presentations for pediatric primary headache and seizure disorders in Calgary, Canada

Background: Climate change, and fossil fuel combustion threaten the health of children globally through direct and indirect mechanisms,1 such as the exacerbation of ambient air pollution.1,2 Increased ambient air pollutant concentrations are associated with emergency department (ED) visits for episodic and paroxysmal neurologic conditions in adults in the Toronto region of Canada.4,5 We hypothesize that, in Calgary, Alberta, increased ambient air pollutants will be positively associated with the daily burden of pediatric ED presentations for migraine and seizures, and that a greater effect size may be present due to increased regional variability in ambient PM2.5 concentrations.3,4 Methods: Emergency records from the National Ambulatory Care Reporting System, comprising 17552 primary seizure and headache cases between 0-18 years of age and presenting to Calgary-region emergency departments between January 2012-December 2021, will be included. Quasi-Poisson regression modeling incorporating ambient air pollutants, seasonality and meteorological covariates will estimate relative risk and 95% confidence intervals of ED visit counts relative to increases in air pollutants. Results: Results currently pending and will be available for presentation. Conclusions: Significant results may inform further inquiry into the impact of air pollutants on children with neurological conditions and identify potential contributions of air quality to healthcare service demand in the Calgary region.

Chronic Pediatric Headache as a Manifestation of Shunt Over-Drainage and Slit Ventricle Syndrome in Patients Harboring a Cerebrospinal Fluid Diversion System: A Narrative Literature Review.

The main subject of the current review is a specific subtype of headache, which is related to shunt over-drainage and slit ventricle syndrome, in pediatric patients harboring an implanted shunt device for the management of hydrocephalus. This clinical entity, along with its impairment regarding the quality of life of the affected individuals, is generally underestimated. This is partly due to the absence of universally agreed-upon diagnostic criteria, as well as due to a misunderstanding of the interactions among the implicated pathophysiological mechanisms. A lot of attempts have been performed to propose an integrative model, aiming at the determination of all the offending mechanisms of the shunt over-drainage syndrome, as well as the determination of all the clinical characteristics and related symptomatology that accompany these secondary headaches. This subcategory of headache, named postural dependent headache, can be associated with nausea, vomiting, and/or radiological signs of slim ventricles and/or subdural collections. The ultimate goal of our review is to draw clinicians' attention, especially that of those that are managing pediatric patients with permanent, long-standing, ventriculoperitoneal, or, less commonly, ventriculoatrial shunts. We attempted to elucidate all clinical and neurological characteristics that are inherently related to this type of headache, as well as to highlight the current management options. This specific subgroup of patients may eventually suffer from severe, intractable headaches, which may negatively impair their quality of daily living. In the absence of any other clinical condition that could be incriminated as the cause of the headache, shunt over-drainage should not be overlooked. On the contrary, it should be seriously taken into consideration, and its management should be added to the therapeutic armamentarium of such cases, which are difficult to be handled.