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Visual evoked potentials in the diagnosis of headache before 5 years of age
1Paediatric Division, Shiba Medical Centre, Affiliated to Sackler Faculty of Medicine,Tel Aviv University, Israel.
Insights
Diagnosing pediatric headache, especially in young children, relies on clinical assessment. While neuroimaging offers limited value, visual evoked potentials may aid in diagnosing conditions like migraine when symptoms are unclear.
Area of Science:
- Pediatric Neurology
- Neurophysiology
Background:
- Headache is a frequent pediatric complaint, posing diagnostic challenges in children under five due to limited history and examination data.
- Clinical diagnosis and treatment are standard, but the unreliability of subjective and objective findings in very young children necessitates exploring diagnostic tools.
Purpose of the Study:
- To evaluate the diagnostic utility of neuro-imaging and visual evoked potentials (VEPs) in children under five presenting with headache.
- To determine the effectiveness of these diagnostic modalities when clinical information is scarce.
Main Methods:
- Retrospective review of 53 children under five with headache.
- Analysis of neuro-imaging studies (CT, MRI) and visual evoked potentials (VEPs) in 42 of the children.
- Comparison of VEP parameters (latencies and amplitudes) between children with and without clinically diagnosed migraine.
Main Results:
- Neuro-imaging studies were largely unremarkable, revealing only two incidental findings (arachnoid cyst, cerebellar hypoplasia) unrelated to the headaches.
- Visual evoked potentials showed no significant differences in N1P100 and N2 latencies between migraine and non-migraine groups.
- However, P100-N2 amplitudes in VEPs were significantly larger in children diagnosed with migraine.
Conclusions:
- Neuro-imaging has minimal diagnostic value for headaches in this young age group.
- Visual evoked potentials can serve as a valuable adjunctive diagnostic tool for pediatric headache, particularly for migraine, when clinical presentation is ambiguous or unavailable.
Unlabelled:
Headache is a common complaint in children. Diagnosis of the type of headache and therapeutic approach is predominantly clinical based on a detailed history and physical examination. These data are often not available or informative in young children with headache, leading clinicians to look for diagnostic studies. We reviewed our experience with 53 children under the age of 5 years with headache. Of these, 42 (75%) children underwent neuro-imaging studies including CT scan (32 cases), MRI (10 cases), or both studies (6 cases). All were within normal limits except for two cases with a small arachnoid cyst and cerebellar hypoplasia respectively which were not directly related to the headache. Visual evoked potentials were performed in all children. There were no significant differences between the mean latencies of N(1)P(100) and N(2) of the children with clinically diagnosed migraine, however, the P(100)-N(2) amplitudes of children with migraine were significantly larger compared to those of children without migraine. Even in young children with headache, neuro-imaging studies have a very limited diagnostic value. Visual evoked potentials may also be used in this age group as a diagnostic tool, particularly when clinical symptoms are either unavailable or not characteristic.
Conclusion:
The diagnosis of migraine in young children remains clinical, based on history obtained from children and parents; however, visual evoked potentials may support the diagnosis in this age group.