16th European Headache Congress

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Characterising the extended phenotype of paediatric migraine: a prospective study

Abstract text (incl. figure legends and references) Question We set out to perform prospective extended phenotyping of children presenting to a tertiary headache service. Methods Consecutive new migraineurs presenting to the Children"s Headache Clinic at Great Ormond Street Hospital for Children between 6th January- 6th September 2022 were included (n=51). A detailed headache history was taken at the first consultation by a trained headache physician. A questionnaire was used to ensure complete symptomatic capture. Data were tabulated and analysed (IBM SPSS v 28). Descriptive statistics, Chi-square and Pearson correlation analyses were used. Significance was assessed at P &lt; 0.05. Results Patients were 69% female and aged 8-16 years (mean 13, SD 2), with mean disease duration 5 years (SD 3). Baseline monthly headache frequency was 1-30 days (median 30, IQR 10-30). Chronic migraine was the most common diagnosis (61%). Aura was present in 45%. At least one infantile migraine marker was present in 71%; the most common were travel sickness (45%) and colic (41%). At least one premonitory symptom (PS) was reported by 94%, at least one cranial autonomic symptom (CAS) by 71% and premonitory CAS by 18%. Vertigo, allodynia and neck stiffness were also reported. The most common perceived triggers were stress (43%), concentration (22%) and bright lights (22%). CAS and headache lateralities co-associated (ꭓ2 15, P=0.005). There was a positive correlation between disease duration and the number of PS reported (Pearson correlation coefficient 0.3, P=0.026). There was a negative correlation between gestational age at birth and number of PS reported (Pearson correlation coefficient -0.4, P=0.009). Conclusion The extended paediatric migraine phenotype includes several non-canonical migraine symptoms. Similarly to in adults, CAS can occur prior to headache and tend to lateralise with headache. There may be an association of PS with disease chronicity and a suggestion that prematurity is associated with more PS.

Headache in children and adolescents 

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Prof.

Sleep Disorders in Pediatric Migraine: a questionnaire-based study

Abstract text (incl. figure legends and references) Migraine and sleep disorders are frequently comorbid and linked by a mutual dependance, possibly representing the expression of a common pathogenic process. This study aimed to analyze the relationship between headache features (migraine frequency and severity, presence of migraine equivalents, use and efficacy of medications) and sleep in pediatric migraine. Parents of children and adolescents with migraine completed two standardized sleep assessment questionnaires, the Children"s Sleep Habits Questionnaire (CSHQ) and the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), and answered questions about headache characteristics in their children. The presence of sleep disorders was defined according to CSHQ"s total score. The CSHQ revealed a sleep disturbance in 72.9% of 140 subjects, but only 5.0% had already received a diagnosis. Patients with sleep disturbances presented statistically significant higher headache frequency (p=0.031) and higher prevalence of migraine equivalents (p=0.007). A higher CSHQ"s total score was associated with higher frequency of severe attacks (p=0.012) and lower efficacy of acute medications (p=0.003). Significant positive correlations of sleep onset delay (p=0.006), sleep duration (p=0.005) and nightwakings (p=0.047) subscales with migraine frequency also emerged. Only 2.8% of patients reached a clinically significant score in the ESS-CHAD. Our findings indicate that sleep disorders are highly prevalent in pediatric migraine and frequently associated with higher headache severity and lower response to acute therapy, but often remain underdiagnosed. Given the relationship between sleep and migraine characteristics, improving sleep quality, through sleep hygiene interventions and specific treatments, could help to reduce migraine intensity and disability and vice versa.

Migraine

Interictal cognitive performance in children and adolescents with primary headache: a narrative review

Abstract text (incl. figure legends and references) Question. Primary headache is a very common and disabling disease. The burden of pain and recurrent attacks may lead to a poor quality of life, anxiety and depression. An increased risk of low functioning and curricular performances in young patients with primary headache has been described. The mechanisms underlying the relationship between migraine and poor school achievement may be various and could be a reflection of weak cognitive skills. Data concerning the cognitive functioning in the free pain interval in pediatric age are under-investigated and results are far from conclusive. Methods. Suitable studies were identified using MEDLINE and Web of Science. Search terms included &quot;Pediatric migraine&quot; or &quot;Pediatric headache&quot; and &quot;Cognitive performance&quot;, &quot;Cognitive impairment&quot; or &quot;Neuropsychology&quot;, &quot;Intelligence&quot;, &quot;Attention&quot;, &quot;ADHD&quot;, &quot;Memory&quot;, &quot;Language&quot;, &quot;Visuo-spatial&quot;, &quot;Coordination&quot; and &quot;Difficulties&quot; or &quot;Problems&quot;. We considered papers involving subjects of an age ranging from 0 to 18 years. We also included articles that, though focusing on adults, included subjects &lt; 18 years old. Results. The present review article suggests that, though considered a benign disease, pediatric migraine may be associated to altered neuropsychological functioning in the interictal phase. Although children and adolescents with migraine generally have a normal intelligence, they may show a not homogeneous cognitive profile, characterized by possible difficulties in verbal skills, in particular comprehension abilities. Pediatric primary headache may present altered neuropsychological functioning involving attentional resources, processing speed and memory, particularly verbal memory. Conclusions. Given the impact that this disease can have on school performance and the tendency to persist from childhood to adulthood, a cognitive screening in young patients affected by primary headache is pivotal. Additional neuropsychological research using more homogenous methods is needed.

Severe abrupt (thunderclap) non-traumatic headache at the pediatric emergency department

Abstract text (incl. figure legends and references) Background: Adult abrupt severe non-traumatic headache (thunderclap) is often related to serious underlying etiologies such as subarachnoid hemorrhage. However, data are sparse regarding thunderclap headache in the pediatric population. Objective: The aim of the study was to evaluate the prevalence, characteristics and causes of thunderclap headache in the pediatric and adolescent population, aged 6–18 years, presenting to a pediatric emergency department. Methods: The electronic database of a tertiary care pediatric emergency department was searched for children presenting with acute headache during 2016–2018. Headache severity was defined by pain scales, either a visual analogue scale or by the Faces Pain Scale–Revised. The study was approved by the Research Ethics Board of Rabin Medical Center (approval no. RMC-19-704). Due to the retrospective study design, the committee waived the need for informed consent Results: During the three-year study period, 104,086 children and adolescents aged 0-18 years were admitted to the pediatric emergency department; of them, A total of 2290 children, aged 6-18 years (mean 13.3 ± 3.26) were admitted with a chief complaint of headache, and reported their level of pain according to one of the two scales used 3112 (3%) presented with acute headaches Thunderclap headache was diagnosed in 19/2290 (0.8%) of the included patients, all of them with a pain score of 10/10. All the patients had a benign course. Primary headache was diagnosed in 15/19 (78.9%), six patients had migraine and eight were diagnosed with primary thunderclap headache. Four of the 19 patients were diagnosed with secondary headache: three with infectious causes and one with malignant hypertension. Conclusions: Thunderclap headache is rare among children and adolescents presenting to the emergency department. This headache is generally of a primary origin. Extensive evaluation is still needed to rule out severe diagnosis problems.

Secondary headaches

Cutaneous allodynia in pediatric and adolescent patients and their mothers – a comparative study

Abstract text (incl. figure legends and references) Background: Allodynia in adults with migraine is related to disease duration. In pediatric patients with migraine, the same proportion reported allodynia in the first six months of migraine presentation as in prolonged disease. This study examined a possible association of migraine pediatric allodynia with maternal allodynia. Methods: We interviewed children with migraine first, and then their mothers, regarding allodynia and headache symptoms. We reviewed hospital charts on pediatric medical background and headache symptoms. Mothers and children older than 11 years filled the Strengths and Difficulties Questionnaire. Mothers gave their informed consent to their participation and their children's participation in the study. of the pediatric participants were collected from the patients" files. The study was approved by the Research Ethics Committee of Rabin Medical Center (approval no. RMC-0294-18RMC). Results: Ninety-eight children with migraine, mean age 13.49±3.1 years, and their mothers, mean age 43.5±6.2 years were recruited to the study. Pediatric allodynia was associated with maternal allodynia; the latter was reported in 82.8% of children with allodynia versus 35.3% of children without allodynia (p&lt;0.001). Maternal migraine was reported in 44 (68.7%) of children with allodynia versus 16.3% without allodynia, p Conclusions: Pediatric allodynia is associated with maternal migraine. Genetic and environmental factors such as maternal behavior may contribute to reduced pain threshold.

Long-term effects of pandemic of Covid-19 on clinical features and psychological symptoms in adolescents with migraine

Abstract text (incl. figure legends and references) Question: We aimed to compare the clinical characteristics of migraine, use of prophylaxis, and psychological symptoms between patients who referred to our Headache Centre before the COVID-19 pandemic and those who were evaluated during the pandemic, with a further distinction between the first phase and the prolonged second phase. Methods: We studied 418 adolescents with migraine (m.a. 14±1.7; 110 M and 308 F). Based on the pandemic period, patients were grouped into 'Pre Covid' or 'Covid'. Moreover, the second group was divided into 'Covid 1' (March to October 2020, characterised by lockdown) and 'Covid 2' (November 2020 to January 2022, characterised by prolonged restrictions). Patients were grouped into: (1) high frequency (weekly to daily episodes) and low frequency (≤3 episodes per month); (2) mild and severe pain; (3) need for prophylactic treatment or not. The PHQ-9 and GAD-7 questionnaires were used to assess anxiety and depression symptoms. Results: We did not find a significant difference in migraine frequency between the "Pre Covid" and "Covid" periods (p=0.295). In the "Covid 2" period, frequency of the attacks was increased, compared to both the "Pre Covid" period (p=0.038) and the "Covid 1" period (p=0.005). Furthermore, more patients needed prophylactic treatment in the 'Covid' period, especially in the 'Covid 2' period (p=&lt;0.001), than in the 'Pre Covid' period (p=&lt;0.001). Our patients showed higher levels of anxiety and depression during the 'Covid' period (GAD-7, p=0.013 and PHQ-9, p=&lt;0.001), especially during the 'Covid 2' period (p=&lt;0.001). Discussion: Our results show a long-term negative impact of the Covid-19 pandemic on clinical parameters and psychological symptoms of adolescents with migraine. Considering the relationship between migraine severity and emotional symptomatology, our results suggest that monitoring the emotional status of pediatric patients with migraine is mandatory in the near future of COVID-19 pandemic.

From the new diagnostic criteria to Covid-19 pandemic passing throught the placebo effect. What have we learned in the management of pediatric migraine over the past 5 years? The opinion of Italian pediatric headache centers

Abstract text (incl. figure legends and references) Questions. What have we learned in the management of pediatric migraine over the past 5 years? Methods. We interviewed the heads of the Italian pediatric headache centers and reviewed literature data from the last 5 years. Results. Diagnostic Criteria. The ICHD-3 still does not have a section dedicated to childhood migraine and continue to have limits when applied to developmental age. One of the most discussed points of the ICHD-3 is having again brought the minimum duration of the migraine attack to 2 hours and no longer to 1 hour as in the previous version. Therapy. Preliminary results showed that the use of CGRP monoclonal appears to benefit adolescents with chronic refractory headaches. Pending monoclonal antibodies, pediatric migraine prophylaxis is still based on the use of traditional drugs and non-pharmacological therapies of which we have few controlled data. In 2017 the results of CHAMP trial were published.This study showed that there were not differences in reducing frequency of attacks in the amitriptyline, topiramate, and placebo groups. The study had limitations such as the long follow-up period, the behavioural interventions and the exclusion of severe migraines and younger children. Then it did not consider an untreated group to separate a real placebo effect from a placebo response. The Covid 19 pandemic. The rest from school and reduction of stress during the lockdown of march 2020 led to a significant improvement in the headache trend also in chronic and drug resistant children. These results suggested that the management of emotional and psychological factors is mandatory for the management of headache in children and adolescents. Conclusions. Few steps forward have been made for the management of pediatric headache in terms of facilitating the diagnostic process and drug treatment. The era of the Covid 19 pandemic showed us how much t management of anxiety, stress and depression are fundamental to reach the goal of a migraine control in children.

The influence of anxiety and depression on headache in adolescent migraineurs: A case-control study

Abstract text (incl. figure legends and references) Introduction: Migraine is a highly prevalent and disabling neurological disorder which is commonly linked to a range of psychiatric comorbidities, primarily anxiety and depression. The present study compared the frequency of anxiety and depression disorders in migraine and non-migraine adolescents and evaluated the effect of depression and anxiety on migraine characteristics. Methods: In this case-control study, 234 adolescents (112 cases with migraine and 122 non-migraine adolescents) aged 13-18 years were evaluated for the presence of anxiety and depression and the influence of these factors on migraine headache. A headache questionnaire as well as the Beck Anxiety Inventory (BAI) and Children&quot;s Depression Inventory (CDI) were completed to investigate the prevalence of headache, anxiety, and depression. Results: The average age of participants was 15.77 ± 2 years in the case group and 15.39 ± 1.79 years in the control group. Among them, 19.8% were boys and 80.2% were girls. We found significantly higher levels of mild, moderate, and severe anxiety (38.4%, 23.2% and 23.2%, respectively) in the migraine group compared to the control group (24.2%, 5.8% and 10.0%. respectively). Non-depressive CDI scores were significantly lower in the migraine group (10.1%) than in the control group (29.6%). There was a significant difference between patients with moderate and severe anxiety in terms of attack frequency and duration. In addition, depressed migraineurs recorded higher attack severities and frequencies than migraineurs without depression. Conclusion: Anxiety and depression are common in adolescents with migraine and can be associated with more burdensome attacks. This makes it necessary to consider anxiety and depression among adolescent migraineurs and provide a therapeutic protocol for this issue. Keywords: Headache, Migraine, Depression, Anxiety, Adolescents

Abnormal eye movements in a girl with Vestibular migraine: a case report and review of the literature

Abstract text (incl. figure legends and references) Vestibular migraine (VM) is a complex disorder with an estimated prevalence of 1-3%.1 VM is most common cause of recurrent spontaneous vertigo.2 During acute VM attacks spontaneous and positional nystagmus can be seen.3 This case of vertigo and nystagmus may be misdiagnosed as BPPV or Meniere disease. A 10 years old girl visited our clinic with her parents complaining of abnormal eye movement with vertigo. She had a history of headache from 3 years ago that were unilateral, in temporal region. She has photophobia. Headache were aggravated by activity and had severe intensity. After starting the headache patient had a vertigo that caused imbalance which lasts 10-60 minutes. During the vertigo her parents reported abnormal eye movement, which documented by camera. Videos showed pendular nystagmus. Patient was fully awake and aware during the attacks. Attacks occur about three times in the month and between them patient is symptom free. She had cyclic nausea and vomiting until 6 years old, that improve spontaneously. All neurologic exams was normal. In MRI she has a few nonspecific bilateral asymmetrical lesions. According to the history and IHC-3, vestibular migraine was made as diagnosis. Patient undergone treatment with Cinarizin 25 mg which resulted in reduction of attacks in 3 months follow-up (only one which was following an emotional stress). This case illustrates that Observation of the nystagmus during a vertigo attacks is helpful for correct diagnosis. exact history taking is important for VM diagnosis, differentiate VM from BPPV, and exclusion CNS consideration. 1.Systematic review of prevalence studies and familial aggregation in vestibular migraine, Ana Paz-Tamayo et al, Frontiers in genetics, 2020 2.Diagnosis and treatment in vestibular migraine, Pinar Yalinay Dikmen, Turkish journal of Neurology,2020 3.Acute migrainous vertigo: clinical and oculographic finding, Michael von Brevern et al, Brain,2005

Allodynia and muscle sensitization of cervical muscles are not associated with neck range of motion in children and adolescents diagnosed with migraine

Abstract text (incl. figure legends and references) Question: To correlate allodynia and sensitization of cervical muscles with neck mobility in children and adolescents diagnosed with migraine. Methods: Fifty children (CH) and adolescents (AD) diagnosed with migraine by ICHD-III were screened, of both sexes, aged between 6 and 17 years at the tertiary headache outpatient clinic. Allodynia was assessed by the adapted allodynia questionnaire based on the ICHD-III and the sensitivity of the cervical muscles by the pressure pain threshold (PPT) using a digital algometer. The active mobility of the cervical spine (ROM) was evaluated in the movements of flexion, extension, lateral flexion, and rotation by the Flexion Rotation Test (FRT), using the CROM®. Results: The mean age of patients was 11.7 years (SD=3.0), most of them female (n=31/62%), with a diagnosis of episodic migraine (n=32/64%), of low intensity (2.4; SD=0.6)), pulsatile quality and duration in hours (18.0; SD=22.7). More than 70% of the sample had some comorbidity associated with the diagnosis of migraine, and neurological diseases, such as epilepsy, were more prevalent in both children (25.2%) and adolescents (26.3%), followed by respiratory diseases in children (20.1%) and psychological conditions in adolescents (19.8%). Pearson's correlation values between PPT and ROM for flexion and extension (rho=0.019 to 0.550) and lateral flexion (rho=0.002 to 0.136) and between PPT and left FRT (rho=0.043 to 0.336) and right FRT (rho=0.051 to 0.336) were classified as weak to moderate and not significant. Correlations between cutaneous allodynia and ROM for flexion and extension (rho=-0.024), lateral flexion (rho=0.278) and rotation (rho=-0.038) and for right FRT (rho=-0.085) and left FRT (rho=0.182), had p&gt;0.05. Conclusion: Cervical sensitization represented by allodynia and LDP appears not to be associated with cervical mobility in the infant population.

Neck-Tongue syndrome: an underrecognized and peculiar form of headache

Abstract text (incl. figure legends and references) Question: Neck-tongue syndrome (NTS) is a rare and underrecognized headache disorder, characterized by paroxysms of neck and/or occipital pain brought out by abrupt head-turning and accompanied by ipsilateral tongue symptoms. Methods: Case-report Results: A 31-year-old woman, hotel receptionist, with a history of alopecia and active smoking, was referred to the Neurology consultation due to monthly episodes of sharp and shooting headache since age 15, characterized as an explosive headache, intensity 10/10, lasting 3-5 seconds, in the occipital region (right predominance), precipitated by ipsilateral neck rotation. During these paroxysms, she used to have a concomitant posterior "tongue-pulling" movement, followed by numbness of the hemi-tongue ipsilateral to the headache, usually lasting less than 1 minute. Episodes of involuntary tongue movements caused discomfort and anxiety due to their social impact. She had a history of minor trauma, after headache debut; no positive family history. On general examination, she showed signs of ligamentous hyperlaxity; normal neurological examination, with no trigger points. The referred episodes were not possible to induce. The blood cell count, erythrocyte sedimentation rate, and chemistry profile were normal. Rheumatoid factor and antinuclear antibody were negative. Cerebral and cervical MRI, and skull base X-ray, were normal. Her clinical features fulfilled the ICHD-3 criteria for a diagnosis of NTS. Conclusions: Our case illustrates the diagnostic delay of this underrecognized condition and the possible etiological link with ligamentous laxity leading to transient subluxation of the atlanto-axis joint. There are currently no consensus treatment guidelines; conservative management, including physiotherapy and minor cervical adjustment, is the preferred initial treatment.

Does symptomatic treatment help children and adolescents with chronic migraine?

Abstract text (incl. figure legends and references) Background and objective. Chronic migraine (CM) is defined in the third edition of the International Classification of Headache Disorders (ICHD-3) as the presence of headaches on 15 days or more in a month, at least 8 days showing the migraine phenotype, for more than 3 months. CM affects from 0.6% to 1.8% of children and adolescents and determines a decrease of the quality of life. Aim of this study is to analyze the type of symptomatic drugs used and their efficacy for the treatment of acute migraine attacks in pediatric patients with CM. Methods. We conducted a prospective study by selecting pediatric patients diagnosed with CM in our Department. We administered a questionnaire to the parents of all our pediatric patients with CM according to ICHD-3; questions were focused on symptomatic drugs used for acute migraine attacks and their effectiveness. Results. For the final analysis we considered 91 patients with CM. Only two patients responded to the initial therapy with acetaminophen and only 31 % improved with ibuprofen. Fiftythree % of patients had relief with second-line NSAIDs drugs like ketoprofen, indomethacin, naproxen. Fifty one % of patients did not respond to more than three drugs and 16 % were resistant to all acute treatments. All patients underwent prophylaxis therapy. Conclusions. In our study we have shown that the drugs for acute attack are not very effective in patients with CM and that some patients do not respond to any acute treatment.

Angelman syndrome and cyclic vomiting syndrome: a new potential association – Not all the vomiting are only vomiting!

Abstract text (incl. figure legends and references) BACKGROUND:We well know about clinical manifestations of Angelman Syndrome (AS), including gastrointestinal issues, like vomiting, gastroesophageal reflux disease (GERD) and constipation; we report the case of a pediatric patient suffering from AS and cyclic vomiting syndrome (CVS) together. This association is not yet included among multisystemic features of the syndrome, nor put in differential diagnosis with gastrointestinal issues described. OBJECTIVE:The aim of this case is to open our mind to new possible association with CVS in AS, rarely described before, and put migraine disorders and equivalents in differential diagnosis with gastrointestinal symptoms. METHODS:We report a patient affected by AS who came to our Headache Centre at 8 years of age: from one year,she reported repeated episodes of general complaint with touching her head and eyes, photophobia and phonophobia, retching and vomiting for hours, with recurrence of one attack per month, rarely during sleep. Her history showed recurrent gastrointestinal disturbance; plus, familiar history was positive for migraine from paternal line. Due to her predisposition to epilepsy, she was undergone to EEG registrations, showing no epileptic alterations. RESULTS:In order to explain her vomiting, we had to exclude organic causes often related to AS and, in general, to neurodevelopmental disorders. She was asymptomatic among 2 episodes, with a regular periodicity and more episodes in a brief time. So,we were able to make diagnosis of CVS and its possible progression to migraine without aura, in accordance with ICHD-3 criteria. She was discharged with acute therapy for migraine and vomiting (ibuprofen and ondansetron). DISCUSSION:We experienced diagnosis of CVS in a patient affected by AS.It seems clear that not all the repeated vomiting in AS is not necessarily part of gastrointestinal manifestation of the syndrome; even if it is only a case, we need to take into account CVS among neurological features of AS.

Clinical characteristics of children and adolescents with primary and secondary headaches in the tertiary-level of a public hospital in Brazil

Abstract text (incl. figure legends and references) Question: To analyze the clinical characteristics of children (CH) and adolescents (AD) with primary and secondary headaches of tertiary-level headache outpatient clinic. Methods: Retrospective study, based on review of medical records of CH and AD with primary or secondary headaches between the years 2016 and 2021. Study data were obtained between the years 2016 and 2021. Sociodemographic data, medical history, clinical history, and daily routine of the child were obtained. The proportion of primary and secondary headaches in the CH and AD groups was also calculated. For continuous variables and categorical data, the chi-square test was used, considering p&lt;0.05. Results: A total of 386 medical records were included, of which 206 were CH (n=112; 54.8% girls) and 178 AD (n=118; 66.8% girls). Headaches were episodic in CH (57.3%) and chronic in AD (49.7%), [X2(2)=10.001; p=0.007], of mild intensity (CR:64.1%); and strong (AD:48.5%), [X2(3)=25.802; p=0.000] in pressure (CR:64.3%) and pulsatile (AD: 52.8%), [X2(5)=14.595; p=0.012]. The chi-square test of independence showed that there is a significant association between CH and the presence of migraine [X2(5)=12,746; p=0.026], type of cesarean delivery [X2(2)=7.299;p=0.026], the use of common analgesics [X2(6)=36.690; p=0.000], discharge from the clinic after migraine treatment [X2(5)=22.225;p=0.000] and between AD and worsening of pain during physical activity [X2(3)=10.671;p=0.014], or pulsatile [X2(5)=14.595;p=0.012], and worsens during menstruation period [X2(6)=21.108;p=0.002]. Conclusion: In both groups, migraine was more prevalent, and females were the most affected. By associating the CH and AD groups, these clinical patterns are significantly different in several aspects.

Associate Professor

Sars-Cov-2 and Headache in Children and adolescents

Abstract text (incl. figure legends and references) Introduction: Headache is identified as a common post-COVID symptom experienced by COVID-19 survivors. Post-COVID headache can be presented in a broad spectrum like headache attributed to systemic infection, increasing intensively and frequency of already existing primary headache and also late-onset new daily persistent headache. Objectives: Accumulating evidence suggests that that headache onset during the presymptomatic or symptomatic phase of COVID-19 may resemble tension-type or migraine headache. Headache itself associated with a shorter symptomatic period. Our objectives were to determine correlation between Covid 19 and headache in children and adolescents. Methods: We have observed 59 patients with post-COVID headache, 21 boys and 38 girls. Migraine was diagnosed in 19 patients, cluster type headache in 4 and stress-related (tension) headaches in 31. Also, Study included 46 patients with headache, but they had no Sars-Cov-2. Children"s age was 6–17 years in both group. Sars-Cov-2 was identified by PCR test and Headache was assessed by daily dairies and clinical examination. Results: Children with SARS-CoV-2 illness and pre-existing Headaches were three-and-a-half times more likely to develop worsening of Headaches than those without pre-existing Headaches. Compared with the control group, on a daily basis the number and intensity of headache were almost more than a third in patients who had Covid 19 in past. Conclusions:Cases of long coronavirus disease (COVID) headache have already been documented in adults, but literature on similar cases in children and adolescents is scant. Although the association between new daily persistent headache and COVID-19 remains unclear, these cases highlight the importance of awareness of the neurological sequelae of novel coronavirus infection in children and adolescents.

Poster session 18

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