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Published on: June 30, 2020
Headaches in children younger than 7 years of age
1Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
Insights
Headaches in young children are usually benign, with migraine being the most common type. Diagnostic tests like neuroimaging are often unnecessary unless specific symptoms are present.
Area of Science:
- Pediatrics
- Neurology
- Child Health
Background:
- Headache is a common concern for parents and physicians in young children.
- Understanding headache types and diagnostic utility in pediatric populations is crucial.
Purpose of the Study:
- To analyze the characteristics and classification of headaches in children under 7 years old.
- To evaluate the effectiveness of diagnostic investigations for pediatric headaches.
Main Methods:
- Retrospective review of 104 children with headache onset before age 7.
- Classification of headache types and assessment of associated symptoms.
- Analysis of neuroimaging and laboratory test results.
Main Results:
- Migraine was the most frequent diagnosis (75%), predominantly common migraine.
- Post-traumatic headaches comprised 12% of cases.
- Associated symptoms like nausea and vomiting were common in migraineurs; neuroimaging and lab tests yielded few significant findings.
Conclusions:
- Headaches in young children are generally benign, even when referred to specialists.
- Neuroimaging has a low diagnostic yield in pediatric headaches without specific red flags.
- Diagnostic workup should be guided by clinical presentation rather than routine testing.
Abstract:
Headache in young children is frequently a cause of concern to parents and physicians. We have reviewed our experience with 104 children with onset of headaches prior to 7 years of age seen by age 9 years. Headaches could be classified in more than 90% of cases. The most common headache type in this population referred to a child neurologist was migraine that constituted 75% of the cases. Seventy-two of 78 cases were common migraine. Posttraumatic headaches accounted for an additional 12%. Associated symptoms such as autonomic signs, nausea, and vomiting were common, particularly in the migraine group. Neuroimaging studies when performed did not reveal any significant abnormalities. Other laboratory tests were also generally unhelpful. No child has gone on to develop new neurologic abnormalities or evidence of an intracranial tumor. We conclude that even in young children headaches are generally benign. Even in this population, neuroimaging studies have a very low yield in the absence of other symptoms and findings and are not always indicated.
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