title: Seasonal variation of presentation for headache in a pediatric emergency department.
abstract: OBJECTIVE
  Headache is a common pediatric complaint. Our experience indicated that there was a seasonal variation in children seeking emergency department (ED) care for headache. We hypothesized that visits to the ED would be more common during the school year compared with that during the summer months.
  
  
  METHODS
  Electronic medical record data were reviewed from January 1, 2008 through June 30, 2010. All patients age 4 years and older with a chief complaint of headache were examined. Patients with ventriculoperitoneal shunts, intracranial mass, trauma, or stroke were excluded. The following data were accumulated: date of visit, birth date, sex, race, and diagnosis. Visits were grouped by month of occurrence and school year (September through May) and non-school year (June through August). Cumulative binomial probabilities were used to determine the likelihood of experiencing the observed number of occurrences or fewer in each period.
  
  
  RESULTS
  A total of 2731 visits met the inclusion and exclusion criteria. Girls were older, more likely to be white, and more likely to be diagnosed with migraine. There is a clear nadir in May and June and a peak in September, October, and November that is statistically significant (P< 0.001) across age groups, sex, race, and headache type. These findings persisted when comparing the groups based on school year versus non-school year.
  
  
  CONCLUSIONS
  Visits to the ED for headache were less common in May and June and more common during the fall. This remained true across headache type, age, sex, and racial groups.
authors.affiliation: From the *Department of Pediatrics, University of Louisville, Louisville, KY; and †University of Pittsburgh, Pittsburgh, PA.
authors.forename: Kerry
authors.initials: K
authors.lastname: Caperell
authors.forename: Raymond
authors.initials: R
authors.lastname: Pitetti
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006261:Headache / Q000453:epidemiology*; D006801:Humans; D008297:Male; D010372:Pediatrics; D012621:Seasons