Objectives The aims of the study were (1) to analyze the etiology and clinical management of headaches in children in the emergency department and (2) to analyze the treatment used in children diagnosed with headaches and with migraines. Methods Retrospective study of all the patients who were admitted to the pediatric emergency department of Hospital Professor Doutor Fernando Fonseca, Lisbon, in 2014, with a chief complaint of headaches or the primary discharge diagnosis was headache/migraine. Results Headache related cases represented 3.8% of all the visits, a total of 2354 subjects. The median age was 10 years and 52.6% were female. The most frequent diagnoses were as follow: headaches (21.3%), upper respiratory infections (18.4%), and migraines (6.1%). There were 4 cases of meningitis, 6,5% of all patients underwent computed tomography which was mostly requested in school-age children and adolescents. The average time from the first medical observation until discharge was 85 minutes. Fifty-five percent did not take any pain relief medication, 17.2% took acetaminophen, and 11.1% took ibuprofen. Patients who received ondansetron had less revisits (P = 0.000). Subjects with mild-moderate pain treated with acetaminophen or no medication had more revisits (P = 0.000). Conclusions Secondary benign headaches were the most common and very rarely headache as a symptom was associated with life-threatening situations. Antiemetics seem to be efficient ally in the treatment of primary headaches, but it is important to consider alternative pharmacological regimes in patients who present with higher pain scores.

Abstract. The aim of this study was to characterize the infection by respiratory syncytial virus (RSV), identify risk factors, complications and compare treatment strategies in children admitted to two Portuguese hospitals. It was a retrospective study performed between January 2005 and December 2006. Demographic and socioeconomic data, risk factors, treatment, complications and medical follow-up were analyzed. A total of 328 children were studied (135 from Hospital Dona Estefânia and 193 from Hospital Fernando Fonseca), about half (52.7%) being male, with a mean age of 5 months. 41% of the patients were from a poor socioeconomic context, 55.8% had older siblings, 32.2% had smoking parents and 11.3% had reactive airway disease. Complications occurred in 76.1% of the patients, namely, hypoxemia (63.5%), secondary bacterial infection (26.5%), atelectasis (11.5%), respiratory failure (10%) and apnea (2.4%). Most of the patients (92.3%) were treated with bronchodilators, 69% had oxygen supplementation, 45% were on antibiotics and 31% were treated with systemic corticosteroids. Ten percent needed mechanical ventilation. Twenty-seven (8.2%) children developed reactive airway disease. Having older siblings (63.1% vs. 49.3% P = 0.05) and being newborn (32.7% vs. 16.5% P = 0.006) resulted as risk factors for complications, while the risk factors identified for bacterial infection were having older siblings (71.4% vs. 55.7%; P = 0.013) and being from a poor socioeconomic context (64.7% vs. 47.6%; P = 0.017). The treatment strategies differed in the two hospitals (Hospital Fernando Fonseca vs. Hospital Dona Estefânia) regarding the use of systemic corticosteroids (1.6% vs. 73.3%, P = 0.000) and antibiotics (39.4% vs. 52.6%; P = 0.011). RSV infections can result in serious complications. According to the current knowledge, most of the therapeutic measures carried out in this study were probably unnecessary. It is important to establish clear national guidelines for the treatment of RSV infection.