Red Ear Syndrome in Children May Be Highly Specific for Migraine

Laurie Barclay, MD

January 14, 2011

January 14, 2011 — Red ear syndrome (RES) in children is a highly specific sign for migraine, according to the results of a study reported online December 1 in Cephalalgia.

"[W]e were the first to report a possible association between RES and migraine, and more recently other authors hypothesized a crossover between RES and other primary headaches, such as trigeminal autonomic cephalalgias (TACs)," write V. Raieli, from U.O. di Neuropsichiatria Infantile in Italy, and colleagues. "There are still few data, nevertheless, about the frequency of the RES in the general population, its semeiological value or its relationship with primary headaches."

The goals of the study were to determine the frequency, specificity, and sensitivity of RES in a sample of children (aged 4 - 17 years) with migraine and to identify the pathophysiology underlying RES associated with migraine.

Of 226 children with headache enrolled in this study, 172 (76.4%) had migraine, and 54 (23.6%) had other primary headaches. RES occurred in 23.3% of children with migraine vs 3.7% of children with other types of headache (P < .0001). The specificity of RES for migraine was 96.3%, and the positive predictive value was 95.3%.

In children with migraine, RES attacks were bilateral in 65% and lasted less than 1 hour in 35% of children (although duration was not determined in 50%). In 85% of patients who reported RES, this developed during the headache phase. However, most children with RES did not report an association with all migraine attacks.

RES was statistically significantly associated with male sex, throbbing quality of headache pain, vomiting, and phonophobia, based on univariate statistical analysis. In a multivariate stepwise logistic regression model, however, significant associations remained only for throbbing pain, vomiting, and male sex.

"Our study showed that in children, RES is a highly specific sign for migraine," the study authors write. "In addition, the evidence of an association of RES with some migraine features partially provoked by the parasympathetic system supports the hypothesis of a shared pathophysiological background (e.g. via the activation of the trigeminal-autonomic reflex)."

Limitations of this study include retrospective analysis, lack of a systematic analysis of local autonomic symptoms, and lack of generalizability to adult patients with migraine.

"[I]n our opinion, RES is a very useful clinical marker in the pediatric age group, and should be used by physicians to diagnose migraine, together with other migraine features such as vomiting, localization of pain or behavior of the child during the attack," the study authors conclude.

The study authors have disclosed no relevant financial relationships.

Cephalalgia. Published online December 1, 2010. Abstract


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