"Benign" imaging abnormalities in children and adolescents with headache

Area of Science:

• Pediatric Neurology
• Neuroradiology
• Medical Imaging

Background:

• Headache is a common presenting complaint in pediatric neurology.
• Brain imaging is frequently utilized to evaluate headaches in children.
• Distinguishing benign from clinically significant findings is crucial for patient management.

Purpose of the Study:

• To determine the frequency of benign abnormalities on pediatric brain imaging in headache patients.
• To compare the incidence of benign findings with those requiring a change in management.
• To explore the association between benign imaging findings and headaches in children.

Main Methods:

• Retrospective review of 681 pediatric headache patients over two years.
• Comparison of patients with benign versus non-benign imaging findings.
• Definition of benign abnormalities as those not altering patient management.
• Literature review to discuss benign findings and their headache association.

Main Results:

• 35.4% of patients had imaging; 19.1% revealed benign abnormalities (e.g., sinus disease, Chiari I malformations, white matter abnormalities).
• 9.5% had findings requiring management changes, including tumors, infarcts, and vascular issues.
• Excluding sinusitis, only 1.2% of patients without neurological deficits had imaging findings necessitating a management change.

Conclusions:

• Benign abnormalities are common in pediatric headache imaging, found in approximately 20% of cases.
• Clinically significant imaging findings are infrequent in children with headaches and no neurological abnormalities.
• These results support a selective approach to brain imaging in pediatric headache evaluation.