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New practice parameters: what does the evidence say?
1Division of Pediatric Neurology, Children's Hospital of the King's Daughters, Eastern Virginia Medical School, Norfolk, VA 23507, USA. dlewis@chkd.com
Insights
The American Academy of Neurology advises against routine lab tests and EEGs for children with recurrent headaches. Neuroimaging is only recommended if a neurological exam is abnormal or specific concerning symptoms are present.
Area of Science:
- Neurology
- Pediatrics
- Headache Medicine
Background:
- The American Academy of Neurology has released practice parameters for pediatric headache management.
- These guidelines address the evaluation and treatment of headaches in children and adolescents.
Purpose of the Study:
- To summarize the recommendations for evaluating recurrent headaches in children.
- To outline indications for neuroimaging and discuss acute and preventive therapies for pediatric migraine.
Main Methods:
- Review of practice parameters published by the American Academy of Neurology.
- Analysis of data regarding laboratory investigations, electroencephalography (EEG), and neuroimaging for pediatric headaches.
- Evaluation of evidence for acute and preventive migraine therapies in pediatric populations.
Main Results:
- Routine laboratory investigations and EEG are not recommended for children with recurrent headaches and normal neurological examinations.
- Neuroimaging is advised for children with recurrent headaches only if there are concerning historical features or abnormal neurological findings, such as focal deficits, signs of increased intracranial pressure, altered consciousness, or seizures.
- The second parameter addresses acute and preventive treatments for pediatric migraine.
Conclusions:
- The guidelines emphasize a selective approach to diagnostic testing for pediatric headaches, prioritizing clinical assessment.
- Neuroimaging should be reserved for cases with specific red flags indicating potential underlying neurological pathology.
- Evidence-based therapeutic strategies for pediatric migraine are also reviewed.
Abstract:
The American Academy of Neurology recently has published two practice parameters pertaining to children and adolescents with headache. The first focuses attention on the appropriate evaluation of the child with recurrent headache and reviews the data regarding laboratory investigation, electroencephalography (EEG), and neuroimaging. Routine laboratory investigation and EEG are not recommended. Neuroimaging is not recommended for children with recurring headaches and a normal neurologic examination unless there are historic features to suggest the recent onset of severe headache, change in the type of headache, or associated features that suggest neurologic dysfunction. If there are abnormalities on the neurologic examination (eg, focal findings, signs of increased intracranial pressure, significant alteration of consciousness) or the coexistence of seizures, then neuroimaging is recommended. The second parameter evaluates relevant data regarding the acute and preventive therapies for pediatric migraine.
