title: Monthly variation of United States pediatric headache emergency department visits.
abstract: OBJECTIVE
  The objective of this article is to determine the monthly variation of emergency department (ED) visits for pediatric headache. We hypothesized youth have increased headache-related ED visits in the months associated with school attendance.
  
  
  METHODS
  Using a United States representative sample of ED visits in the National Hospital Ambulatory Medical Care Survey from 1997 to 2009, we estimated number of visits associated with ICD-9 codes related to headache, migraine, status migrainosus, or tension-type headache in 5- to 18-year-olds. Age-stratified multivariate models are presented for month of visit (July as reference).
  
  
  RESULTS
  There was a national estimate of 250,000 ED visits annually related to headache (2.1% of total visits) in 5- to 18-year-olds. In 5- to 11-year-olds, the adjusted rate of headache-related visits was lower in April (OR 0.42, 95% CI 0.20, 0.88). In 12- to 18-year-olds, there were higher rates in January (OR 1.92, 95% CI 1.16, 3.14) and September (OR 1.64, 95% CI 1.06, 2.55).
  
  
  CONCLUSIONS
  In adolescents we found higher ED utilization in January and September, the same months associated with school return from vacation for a majority of children nationally. No significant reduction in the summer suggests that school itself is not the issue, but rather changes in daily lifestyle and transitions.
authors: Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, CO, USA.
authors: Sita
authors: S
authors: Kedia
authors: Adit A
authors: AA
authors: Ginde
authors: Joseph A
authors: JA
authors: Grubenhoff
authors: Allison
authors: A
authors: Kempe
authors: Andrew D
authors: AD
authors: Hershey
authors: Scott W
authors: SW
authors: Powers
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006261:Headache / Q000453:epidemiology*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D014481:United States
keywords: Pediatric; emergency department; headache; school; sleep; stress