Hyperventilation-Induced High-Amplitude Rhythmic Slowing and Its Impact on Migraine Frequency in Children: A Retrospective Observational Cohort Study Publisher



Mohammadi M ; Badv RS ; Rezaei Z ; Ashrafi MR ; Zamani GR ; Heidari M ; Vatanparast M ; Eslamiyeh H ; Ahangari N ; Shirvan BB ; Toosi MB
Source: Iranian Journal of Child Neurology Published:2026

Abstract

Objectives: The most common primary headache disorder in children is migraine. Some children with hyperventilation (HV) may exhibit hyperventilation-induced high-amplitude rhythmic slowing (HIHARS) in their electroencephalogram (EEG). The study aims to evaluate the correlation between HIHARS and a child’s future migraine onset risk. Materials & Methods: The present study evaluated HIHARS during the HV maneuver in children aged 7 to 12 admitted to the Electroencephalography Monitoring Unit for diverse referral reasons. After six years, the researchers assessed Long-term video-EEG monitoring data for migraine disease according to the International Classification of Headache Disorders, Third Edition (ICHD-3). The clinical and neurophysiological data were analyzed using appropriate statistical methods. Results: The study revealed that among children with HIHARS, migraine was higher (P=0.049) after six years. Additionally, 15 children (68.18%) with HIHARS had a family history of migraine, compared to 12 children (40%) without HIHARS, which was significant (P=0.044). Interestingly, no significant difference was observed between patients with seizures and those without (P=0.1), suggesting that seizures do not act as a confounding factor in this study. Conclusion: This is the first study on the correlation of HIHARS with migraine in children. Patients aged 7 to 12 years old with HIHARS had more susceptibility to migraine headaches. It is suggested that children with HIHARS and a history of migraine in first-degree family members will be more susceptible to developing migraine in life. © 2026, Iranian Child Neurology Society. All rights reserved.