Red ear syndrome highly specific sign for migraine in children

Red ear syndrome (RES) in children is a highly specific sign for migraine, according to the results of a study published by Raieli et al in Cephalalgia on December 2010

.Previous studies have suggested a relationship between ‘red ear syndrome’ (RES) and pediatric migraine and a crossover between RES and other other primary headaches, such as trigeminal autonomic cephalalgias (TACs) have also been proposed. The red ear syndrome is a rare syndrome originally described by Lance in 1994. It involves pain in and around the ear and associated autonomic phenomena, the most significant of which is cutaneous erythema of the ear ipsilateral to the pain and obvious to the patient and examiner during the attack.

In this retrospective study, 226 children (aged 4-17yrs) suffering from headache were studied to assess the frequency, specificity and sensitivity of RES in a population of pediatric migraineurs and to establish the pathophysiological mechanisms of Red Ear Syndrome associated with migraine. The authors found that Red Ear Syndrome 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). RES showed a statistically significant association with male sex, throbbing quality of the pain and vomiting. However the authors did not undertake a systematic analysis of local autonomic symptoms and the findings cannot be generalized to adult patients with migraine.

The authors also suggest that 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).

The study results suggest RES as a very useful clinical marker in the pediatric age group, along with other symptoms including vomiting, localization of pain or behavior of the child during the attack.