Investigators from University of Texas Southwestern Medical Center, Dallas, TX, and other centers in the US and London, UK, studied risk factors for headache and migraine in 872 children, age 5 to 15 years (mean age, 9.1 years), with sickle cell disease (hemoglobinSS or hemoglobinSb-thalassemia) and no history of overt stroke or seizures. Recurrent headaches were reported in 317 (36.4%) and migraines in 132 (15.1%). Both were associated with lower hemoglobin and higher rate of hospitalization for pain events requiring hospitalization for treatment with opioids in the previous 3 years. Only six of 317 (1.9%) children reporting recurrent headaches were receiving medication for headache prophylaxis. The prevalence of silent cerebral infarct, diagnosed by MRI and neurological examination, was similar in patients with recurrent headaches and in those without headaches (32.8% and 29%, respectively; P = 0.241). Older age, lower Hgb concentration, and higher pain event rate were associated with recurrent headaches and migraines. 
COMMENTARY. Isolated recurrent headaches or migraine in neurologically normal children with sickle cell disease (SCD) might not necessitate additional evaluation with imaging studies, but new severe headaches presenting acutely warrant further investigation, especially when associated with acute CNS events. In a study of children with SCD who presented acutely with headache, headache was the chief complaint in 3.8% of acute care visits, and acute CNS events occurred in 16.9%. Factors associated with acute CNS events included older age, history of stroke, TIA, or seizure, focal neurological findings, and elevated platelets .