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Headaches in a pediatric emergency department: etiology, imaging, and treatment
1Division of Pediatric Neurology, Schneider Children's Hospital, Long Island Jewish Medical Center, The Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, NY 11040, USA.
Insights
Most pediatric emergency department headaches stem from illness or minor trauma, rarely needing significant medication. Serious neurological causes are uncommon but require prompt medical care.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Diagnostic Imaging
Background:
- Headaches are a common chief complaint in pediatric emergency departments.
- Understanding the causes and management of pediatric headaches is crucial for appropriate care.
Purpose of the Study:
- To analyze the diagnostic spectrum of headaches in children presenting to the emergency department.
- To evaluate the utilization of brain CT scans and pharmacological treatments for pediatric headaches.
Main Methods:
- A retrospective chart review was conducted over one year.
- Data collected included patient demographics, headache etiology, CT scan findings, and treatments administered.
Main Results:
- 130 pediatric patients presented with headaches; most were secondary to illness or minor trauma.
- Serious neurological causes were identified in a small percentage (6.9%) of patients.
- CT scans revealed abnormalities in a minority of cases (approx. 10%); over-the-counter analgesics were the most common pharmacological treatment.
Conclusions:
- The majority of pediatric headaches are benign, often linked to concurrent illnesses or minor head trauma.
- Serious neurological etiologies are infrequent but necessitate urgent medical intervention.
- CT scans should be judiciously used for specific indications, and further research on pharmacological treatments is warranted.
Objective:
To assess the spectrum of diagnoses, the use of CT scans of the brain, and pharmacological treatments in patients presenting to a pediatric emergency department with headaches as the chief complaint.
Methods:
A 1-year retrospective chart review of all children who presented to the emergency department with a headache as the chief complaint.
Results:
One hundred thirty patients (0.7% of all pediatric emergency department visits, mean age = 9.3 years) were included in the study. Primary headaches included 11 migraine (8.5%) and 2 tension headaches (1.5%). Most of the secondary nonneurological headaches were associated with viral and respiratory illnesses (n=37, 28.5%), while the majority of the secondary neurological headaches included 26 posttraumatic (20%), 15 possible ventriculoperitoneal shunt malfunctions (11.5%), and 3 cases of aseptic meningitis (2.3%). The neurological etiology in 9 of these children (6.9%) was found to be serious (subdural hematoma, epidural hematoma, proven ventriculoperitoneal shunt malfunction, brain abscess, pseudotumor cerebri, and aseptic meningitis). Fifteen patients could not be etiologically classified, either because no specific etiology was found or their discharge diagnoses could not clearly explain the headache. Approximately 10% (5/53) of the CT scans of the head that were performed showed new abnormal findings including hydrocephalus secondary to ventriculoperitoneal shunt malfunction (2), subdural hematoma (1), epidural hematoma (1), and skull fracture (1). Forty-two patients (32%) were treated pharmacologically. Thirty-nine of the 42 treated patients (93%) were given over-the-counter analgesics, and 9 (21%) were given prescribed analgesics.
Conclusions:
The majority of the headaches in the pediatric emergency department were secondary to concurrent illness and minor head trauma, and required no pharmacological treatment or only treatment with minor analgesics. In a small minority of patients, headaches were secondary to serious neurological conditions, which required immediate medical attention. Computed tomography scans showed new abnormalities in a minority of patients and should be reserved for those with neurological diagnoses such as head trauma and ventriculoperitoneal shunt, as well as for those patients with recent onset of headaches with no clear etiological explanation, and for those with high-risk medical conditions, such as hypocoagulabilities. Future prospective studies are needed to assess the efficacy of the various pharmacological treatments in this population.