Epidemiological and clinical features of migraine in the pediatric population of Northern Italy.

AIM: The aim of this article is to analyze the epidemiological and clinical features of migraine in a pediatric headache center. METHODS: A retrospective study was performed over six years. Hospital record databases were screened for the diagnosis of migraine with aura (MA) or without aura (MO), based on the ICHD-II criteria. STATISTICAL ANALYSIS: Fisher's test or Mann-Whitney U test, significance at p < 0.05. RESULTS: Migraine was diagnosed in 495 children (29.7% MA, 70.3% MO). The majority of diagnoses were made between ages 9 and 14 years. After stratification for age into five groups, we observed an increase of diagnoses in females, with a peak after the age of 15 years, and an increase of MA. In both groups, the attacks were usually severe, infrequent (<1-3/month) lasting <2 hours, and associated with nausea/vomiting, photophobia, phonophobia (more frequent in MO). Osmophobia was reported in 24.7% of the patients with MO. Dizziness was more frequent in patients with MA. Visual auras were the most common occurrence (87.1%). Confusional state was observed in 10.88% of the patients. A positive family history of headache was observed in >88% of the patients. CONCLUSION: We describe the characteristics of pediatric migraine based on the ICHD-II criteria, showing a likely significant loss of diagnoses using the ICHD-III beta. The incidence of migraine increases with age. MO occurs more commonly and shows more frequent attacks and a higher prevalence of associated symptoms, in particular osmophobia. Although males are prevalent in the entire sample, the proportion of females is higher among patients with MA in all of the age groups. Phenotype and sexual prevalence of migraine acquire adult characteristics and become more frequent in females from the onset of puberty.

Benign paroxysmal torticollis of infancy. A case report.

Benign paroxysmal torticollis of infancy is a benign, rare, probably under-recognised disorder, characterized by recurrent episodes of head tilting. The diagnosis is primarily one of pattern recognition and exclusion of alternatives conditions; other symptoms, such as vomiting, pallor and eyes' rotation, may be associated with or rapidly follow the attack, leading to misdiagnosis of this disease. The exact pathogenesis of benign paroxysmal torticollis is not clear, but a close relationship with childhood periodic syndromes is supposed. Due to the difficulty in defining the disease, this event has implications with respect to the training and education of practice providers and emergency physicians. We describe the case of a 7-month-old infant with benign paroxysmal torticollis recently observed, discuss the clinical presentation and review the literature.