[Headache in childhood: which diagnostic imaging strategies?]

There are various causes of headaches in children. The majority of cases are considered as primary and include migraine and tension headaches. Headaches secondary to an underlying pathology are much less frequent. The aim of imaging will be to depict lesions that can benefit from specific therapy and hence improve life quality and expectancy of the affected child. In case of secondary headaches, imaging will have to precise the diagnosis, which is based mainly upon history of the disease and clinical findings. These findings are important to the radiologist as they will help to choose the more adequate technique between CT scan and MRI. This choice is based upon the presumed diagnoses, degree of emergency and availability of the technique. Knowledge of the differential diagnoses influences the way to perform the examination itself (choice of slice thickness, plane of imaging, MR sequences, need for an MR angiogram or injection of contrast medium...). In our opinion, dedicated MR imaging is the technique of choice to investigate secondary headaches in children given its superior sensitivity in depicting certain tumors (glioma of the pons, posterior fossa tumors...), intracranial hypotension, Chiari I malformation, lesions of the hypothalamo-hypophyseal axis etc...