Prevalence of red ear syndrome in juvenile primary headaches

Cephalalgia. 2011 Apr;31(5):597-602. doi: 10.1177/0333102410388437. Epub 2010 Dec 1.


Background: Previous studies have suggested a relationship between 'red ear syndrome' (RES) and pediatric migraine. Aims of this study were (i) to assess the frequency, specificity and sensitivity of RES in a population of pediatric migraineurs and (ii) to establish the pathophysiological mechanisms of RES associated with migraine.

Methods and results: A total of 226 children suffering from headache (aged 4-17 years) were enrolled. One hundred and seventy-two (76.4%) were affected by migraine, the remaining 54 (23.6%) by other primary headaches. RES was followed significantly more frequently by migraine (23.3%; p < .0001), and was characterized by high specificity and positive predictive value (96.3 and 95.3%, respectively). According to the univariate statistical analysis, RES showed a statistically significant association with male gender, throbbing quality of the pain, vomiting and phonophobia. It was confirmed by a multivariate stepwise logistic regression model only for the throbbing quality of the pain, vomiting and male gender.

Conclusions: Our study showed that (i) in children, RES is a highly specific sign for migraine. 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).

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Ear Diseases / epidemiology*
  • Ear Diseases / etiology*
  • Female
  • Humans
  • Male
  • Migraine Disorders / complications*
  • Prevalence