Meningismus in children with chronic headache is most likely due to streptococcal infection.

We previously found that 97% of children diagnosed with chronic tension-type headaches had meningismus. In the present study, we investigate the relationship between streptococcal infection and meningismus in children suffering from chronic headaches. Six hundred and forty children suffering from idiopathic chronic headaches were examined by a neurologist in an outpatient setting. Antistreptolysin titer (ASOT) was determined from blood samples taken from all the children. Meningismus was diagnosed in 337 patients. Patients were divided into two groups: 337 children (Group 1) with meningismus with an increased ASOT (200-1790 IU/ml) in 264 children (78%), and 303 children (Group 2) without meningismus with an increased ASOT (200-1030 IU/ml) in 117 children (39%). We report herein that a majority of children with headaches associated with meningismus, had evidence of a streptococcal infection when compared to a non-meningismus group. We postulate that streptococcal infection may play an important role in the etiology of meningismus-positive chronic headaches in children.