A series of 83 juvenile patients with idiopathic stabbing headache, 3.3% of all juvenile patients referred because of recurrent headache, is reported from the Paediatric Neurology Services of the University of Ferrara and the University of Padua, Italy. Mean age at onset was 7 +/-3 years, and sexes were equally affected. The pain lasted a fraction of a second to a few minutes. The frequency was more than once a week in 52%, once a week in 21%, and once a month in 27%. Intensity was severe in 30%, and mild in 40%. Localization was frontal in 69% and occipital in 23%; bilateral in 48% and alternating in 22%. Headache associated symptoms in 47% included photophobia (15%), nausea (7%), and vertigo (8%). A psychogenic precipitant was recognized in 22%. A history of periodic syndrome, mainly cyclic vomiting and recurrent abdominal pain, preceded the onset of headache illness in 47%. Family history of migraine was present in 58%. Only 14% of patients had other types of headache in addition; 10% had migraine and 4% tension headache. Neurologic exam, imaging in 32 patients, and EEG in 67 were normal. At 1 to 5 year follow-up, 70% were free of symptoms. [1]

COMMENT. A small group of juvenile headache patients with characteristically very brief attacks of stabbing pain, with onset around 7 years, and spontaneous remission usually within 1 to 5 years, may deserve greater recognition as a childhood headache syndrome with a relatively favorable prognosis. A previous report cited by the authors found a 25% incidence of EEG abnormalities among patients with this syndrome [2]. Others have shown a high incidence of EEG abnormalities in migraine patients and a beneficial response to the anticonvulsant, phenytoin [3]. The use of valproate in headache patients is reviewed in the following article.