The Headbone’s Connected to the…GI Tract?
You just admitted a child with a headache. These patients present a particularly challenging dilemma because the differential diagnosis can be broad and the wide array of testing options (which can be both harmful and expensive) may leave you wondering, “Do I watch and wait, or go looking for things?”
The goal of this case-control examination, conducted in France and Italy, was to determine whether an association exists between infantile colic and migraine headaches. Consecutive children aged 6 to 18 years, who presented to 1 of 3 emergency departments and were diagnosed with migraine or tension-type (according to criteria of the International Headache Classification, 2nd edition) primary headaches between April and June 2012, were enrolled. Control subjects were similar-aged children presenting to the same centers for minor trauma. All parents completed rigorous, criteria-based questionnaires to determine whether their child had a history of infantile colic.
The key findings.
A total of 328 cases (208 with migraine and 120 with tension headaches) and 471 control subjects took part in the study. Characteristics between migraine cases and control subjects were generally similar, although the migraine group was slightly older (10.1 vs 9.0 years; P = .001). Prevalence of a history of colic in the migraine, tension headache, and control groups was 72.6%, 35.0%, and 26.5%, respectively. Logistic regression demonstrated an associated odds ratio between infantile colic and migraine of 6.61 (95% confidence interval: 4.38–10.00); this association was not found for colic or tension-type headaches.
Why do we care?
The first step to narrowing a broad differential diagnosis is a careful history …