Background: Migraine is one of the most frequent primary headaches in childhood. The role of thrombotic predisposition in its pathogenesis is debated. Our aim was to analyse the cardiovascular risk factors and family history of major thrombotic events in children with migraine. Methods: A retrospective, single-centre study was performed over 12 years. Our headache centre record database was screened for migraine with aura (MA) and migraine without aura (MO) on the basis of the ICHD-II (until 2013) and III criteria. A control group of otherwise healthy children was recruited. Descriptive and multivariate analyses are provided; significance was set at p < 0.05. Results: Migraine was diagnosed in 930 children (24.7% MA); 73.3% were 9–14 years old. Children with MA were older (p < 0.001). A family history of cerebral ischemic events at ≤50 years old was more commonly reported by children with MA than those with MO (p < 0.001) and those in the control group (p = 0.001). Children with MA showed a higher risk of a family history of cerebral ischemic events at ≤50 years old than children with MO (OR: 2.6) and those in the control group (OR: 3.1). When comparing the family history of DVT, we observed a significantly increased risk for MA vs. MO (OR: 2.9). Conclusion: A family history of cerebral ischemic events at ≤50 years old leads to an increased risk of MA. Further studies are needed to explore such an association.

Background. The orofacial pain syndromes (OFPs) are a heterogeneous group of syndromes characterized by painful attacks involving the orofacial structures. They may be summarily subdivided into two great categories: (1) orofacial pain mainly attributed to dental disorders such as dentoalveolar and myofascial orofacial pain or temporomandibular joint (TM) pain; (2) orofacial pain mainly attributed to non-dental pain as neuralgias, facial localization of primary headaches or idiopathic orofacial pain. The second group is uncommon, often described by single case reports, can often show overlapping symptoms with the first group, and represents a clinical challenge, carrying the risk of undervaluation and possibly invasive odontoiatric treatment. We aimed to describe a clinical pediatric series of non-dental orofacial pain and better to underline some topographic and clinical features associated with them. We retrospectively collected the data of children admitted to our headache centers (Bari, Palermo, Torino) from 2017 to 2021. Our inclusion criterion was the presence of non-dental orofacial pain following the topographic criteria of 3° International Classification of Headache Disorders (ICHD-3), and exclusion criteria included the pain syndromes attributed to the dental disorders and pain syndromes due to the secondary etiologies Results. Our sample comprised 43 subjects (23/20 M/F, in the range of ages 5–17). We classified them int: 23 primary headaches involving the facial territory during attacks, 2 facial trigeminal autonomic cephalalgias, 1 facial primary stabbing headache, 1 facial linear headache, 6 trochlear migraines, 1 orbital migraine 3 red ear syndrome and 6 atypical facial pain. All patients described debilitating pain for intensity (moderate/severe), 31 children had episodic attacks, and 12 had continuous pain. Almost all received drugs for acute treatment (less than 50% were satisfied), and some received non-pharmacological treatment associated with drug therapy Conclusion. Although rare OFP can occur in pediatric age, it can be debilitating if unrecognized and untreated, affecting the psychophysical well-being of young patients. We highlight the specific characteristics of the disorder for a more correct and earlier identification during the diagnostic process, already difficult in pediatric age, and to define the approach and possible treatment to prevent negative outcomes in adulthood.

Aim To determine the red flags for serious organic causes of headache in children, to analyze if the management of headache in the Pediatric Emergency Department is appropriate, and whether the follow-up may limit repeated visits to the Emergency Department. Methods All the patients ≤ 18 years referred to our pediatric Emergency Department for non-traumatic headache over 5 years were retrospectively reviewed. The patients followed up by the Pediatric Headache Centre were also screened. Statistical analysis was undertaken using the Chi-squared test or Fisher’s exact test and multivariate analysis; significance at p < 0.05. Results 1833 patients (54.6% males) accessed our Emergency Department 2086 times; 62.1% had primary headache, 30.0% had secondary headache, 7.8% received inconsistent diagnosis. Among those with secondary headache, 24 (1.1% of total visits) were diagnosed with serious disorders. The clinical red flags for “serious headache” were: Cranial nerves palsy, strabismus, and drowsiness. One hundred and eighty four patients (8.8 %) underwent neuroimaging (rate of pathological findings: 7.1 %); 37.2 % of the patients received analgesic therapy. One hundred and fifteen patients (6.2 %) returned within three months; 24 of these were referred to the Headache Centre, with only one accessing the Emergency Department again. Conclusions The vast majority of headaches referred to the Pediatric Emergency Department are benign, and primary forms prevail. “Serious headache” is rare and shows typical clinical features and abnormal neurologic evaluation; specific clinical red flags, along with suggestive personal history, should lead the pediatrician to prescribe only appropriate neuroimaging. Pain relief is still insufficient in the Pediatric Emergency Department despite appropriate guidelines. Last, the collaboration with the Headache Centre is crucial to limit repeated visits.

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.

12 cases (30%), 9 food (22.5%), 4 cigarette smoke (10%), 2 food plus perfume (5%), 1 perfume plus cigarette smoke (2.5%), 5 other odours (15%) and 6 undefined (15%). Conclusions Our study showed a lower prevalence of osmophobia in children with headache than that reported in the literature. However, we confirm that osmophobia is more specific for migraine without aura. As already demonstrated in adults and younger patients, osmophobia should be considered in clinical practice as a peculiar symptom useful in the differential diagnosis between migraine without aura and tension-type headache in childhood. Written informed consent to publication was obtained from the patient(s).

moeostasis model of assessment–insulin resistance based on the concentrations of blood sugar (80 mg ⁄ dL) and insulin (29 lU ⁄ mL) by fasting blood sampling revealed 5.7 (normal < 1.6), indicating the remarkably increased insulin resistance. Therefore, we considered that the cause of TIA in the present obese girl was because of temporally worsened hypertension, which was a manifestation of the component of metabolic syndrome. In metabolic syndrome, hypertension may occur, in part, via the effect of insulin on renal sodium reabsorption or sympathetic nervous system activity (3). Furthermore, reduced cerebral vasodilatation in the state of insulin resistance may also enhance cerebrovascular events in metabolic syndrome (4). Metabolic syndrome may increase the risk of cerebrovascular disease, even in children (5). To our knowledge, our case is the earliest manifestation of TIA because of hypertension associated with metabolic syndrome. As similar cases in childhood will increase in the future along with the emerging epidemic of obesity in developing countries, paediatricians should consider the appropriate management of hypertension (1,6) as a modifiable risk factor for cerebrovascular disease.

Background and aims: combined multichannel intraluminal impedance and pH-monitoring (MII/pH) is a new technique identifying refluxes irrespective of acidity and detecting their duration, proximal extent and pH. These features are important when studying gastroesophageal-reflux-disease (GERD) in infants, in which weakly acid refluxes are prevalent. Clinical application of MII/pH is uncommon yet, owing to lack of reference values and difficult interpretation of the variables obtained. Aim of the present study was to investigate the relationship between MII-pH results and clinical outcome on a sample of GERD infants. Methods: infants (age: 0-3 months) with GERD symptoms were studied with MII/pH and submitted to a follow-up consisting in clinical examinations and structured interviews to parents at 3-6-9-12-18-24-36 months to evaluate the presence of symptoms and the therapy effects. Results: 54 patients completed the follow-up (32M; age 33.69±21.78 days; weight 3465.13±791.08 gr.; length 52.08±3.55 cm). 22 and 15 patients were still symptomatic at the age of 6 and 9 months, without difference in MII/pH values between symptomatic and non symptomatic infants. The 12 infants that were still symptomatic at the age of 12 months showed a higher bolus exposure index (BEI) with respect to the healed patients (2.63±1.72% vs 1.72±1.05; p=0.029). Conclusions: MII-pH in first months of life could be useful to identify patients with high risk of presenting GER symptoms for more than 1 year. BEI is a pH independent variable with a significant relationship with symptoms duration. Our data highlight the clinical relevance of MII/pH-detected weakly acidic refluxes in GERD infant.

During the first months of life, modification of body composition occurs rapidly. Studies have reported that breastfed (BF) infants show a different growth pattern than formula-fed (FF) infants, particularly in the first years of life. Methods have been developed for estimating body composition. Even though the majority of these methods, such as isotope dilution techniques, total body nitrogen, and densitometry, provide precise analyses and estimations of the body mass, the use of invasive methods, which lead to an increasing risk of radiation exposure, cause difficulties, especially in pediatrics. Bioelectrical Impedance Analysis (BIA) estimates body composition in children and adults by measuring electrical impedance of body tissue. BIA has been accepted as a body composition measurement by the U.S. National Institutes of Health (NIH 1996). This test consists of applying an alternative current of 800 µA and 50 kHz, which is not perceivable and not dangerous. This technique is based on equations that translate the electrical signals in terms of body composition. The related theoretical assumptions and reference models are applicable and accurate only on selected groups of healthy adults and children.

Background: Biagram vector is derived by plotting direct measurements of reactance and phase angle from the analyzer, which are not dependent on anthropometric characteristics of the subject and it can be considered an emerging method for evaluating the nutritional status in clinical practice. Aim: To calculate and plot the Biagram vector in a sample of healthy infants in their first year of life. Methods: 174 healthy infants (99 male, 75 female) aged under 1 year, born at full term and adequate for gestational age, were enrolled in a cross-sectional study. The sample was divided into three age groups: 0–3.99 months (group A), 4–7.99 months (group B), and 8–11.99 months (group C). Bioelectric impedance analysis (BIA) was performed by a tetrapolar single frequence phase-sensitive impedance analyzer (STA/BIA; Akern Srl, Firenze, Italy). Results: Biagram vector showed an increasing trend (p < 0.05) in the first year of life (group A: 27.9 ± 12.6; group B: 32.1 ± 9.7; group C: 37.2 ± 9.5). Females showed Biagram vector values significantly higher than males in group A (34.7 ± 15.0 vs. 24.0 ± 9.1; p < 0.05). 95% confidence ellipses of Biagram vector for each age group were calculated and plotted and a comparison of our results with published data calculated in older children was conducted. Conclusion: The bivariate analysis of BIA measurements, plotted as a vector in relation to the age, showed an increasing trend with a higher gain rate under 1 year with respect to the following age periods. These data could reflect the variation of body composition in the first years of life and could be of interest to assess the nutritional status for clinical practice.

OBJECTIVE:We assessed the bioelectrical impedance vector distribution in a sample of healthy infants in the first year of life, which is not available in literature.METHODS:The study was conducted as a cross-sectional study in 153 healthy Caucasian infants (90 male and 63 female) younger than 1 y, born at full term, adequate for gestational age, free from chronic diseases or growth problems, and not feverish. Z scores for weight, length, cranial circumference, and body mass index for the study population were within the range of +/-1.5 standard deviations according to the Euro-Growth Study references. Concurrent anthropometrics (weight, length, and cranial circumference), body mass index, and bioelectrical impedance (resistance and reactance) measurements were made by the same operator. Whole-body (hand to foot) tetrapolar measurements were performed with a single-frequency (50 kHz), phase-sensitive impedance analyzer. The study population was subdivided into three classes of age for statistical analysis: 0 to 3.99 mo, 4 to 7.99 mo, and 8 to 11.99 mo. Using the bivariate normal distribution of resistance and reactance components standardized by the infant's length, the bivariate 95% confidence limits for the mean impedance vector separated by sex and age groups were calculated and plotted. Further, the bivariate 95%, 75%, and 50% tolerance intervals for individual vector measurements in the first year of life were plotted.RESULTS:Resistance and reactance values often fluctuated during the first year of life, particularly as raw measurements (without normalization by subject's length). However, 95% confidence ellipses of mean vectors from the three age groups overlapped each other, as did confidence ellipses by sex for each age class, indicating no significant vector migration during the first year of life.CONCLUSIONS:We obtained an estimate of mean impedance vector in a sample of healthy infants in the first year of life and calculated the bivariate values for an individual vector (95%, 75%, and 50% tolerance ellipses).