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Headache in an Italian pediatric emergency department
Paola Scagni1, Rosaura Pagliero
1Department of Pediatrics, Headache Center, Children's Hospital Regina Margherita, P.zza Polonia 94, 10126 Torino, Italy. scagni@hotmail.com
Insights
Pediatric emergency department visits for headache are common, with primary headaches and viral illnesses being most frequent. Referral to a headache center can reduce repeat visits and improve diagnosis.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Epidemiology
Background:
- Headache is a common presenting complaint in pediatric emergency departments (EDs).
- Understanding the epidemiology, diagnostic work-up, treatment, and follow-up is crucial for effective management.
Purpose of the Study:
- To assess the epidemiology, diagnostic work-up, treatment, and follow-up of children presenting to the ED with non-traumatic headache.
- To identify factors associated with repeat ED visits and the effectiveness of headache center referrals.
Main Methods:
- Retrospective review of 550 non-traumatic headache visits to a pediatric ED over 12 months.
- Analysis of headache center charts one year after ED visits.
- Categorization of diagnoses into primary, secondary, and unclassified headaches.
Main Results:
- Primary headaches (56.7%) and secondary headaches (42%, mostly viral illnesses) were the most common diagnoses.
- Serious underlying disorders were found in 4% of patients, often associated with neurological signs.
- Only 40.5% received pharmacological treatment, and 20.7% attended a referred headache center, which was associated with fewer repeat visits.
Conclusions:
- Primary headaches and viral illnesses are the leading causes of pediatric ED headache visits.
- Neurological signs aid in identifying serious secondary headaches, potentially reducing the need for extensive investigations.
- Referral to specialized headache centers is recommended to improve diagnostic accuracy and decrease recurrent ED visits.
Abstract:
The objective of this study was to assess epidemiology, diagnostic work-up, treatment and follow-up of children presenting to emergency department (ED) with headache. Records of visits for non-traumatic headache to the ED of a pediatric hospital over a period of 12 months were retrospectively reviewed. Headache center charts were analyzed one year after. Five-hundred and fifty patients (1% of all ED visits) were included. Spectrum of diagnoses was: primary headache (56.7%), with 9.6% of migraine; secondary headache (42%); unclassified headache (1.3%). Viral illnesses accounted for 90.5% of secondary headaches. A serious disorder was found in 4% of patients. Forty-four patients (8%) underwent neuroimaging studies, with 25% of abnormal findings. Only 223 patients (40.5%) received pharmacological treatment. On discharge, 212 patients (38.5%) were referred to headache center and 114 (20.7% of all patients) attended it. ED diagnosis was confirmed in 74.6% of cases. Most of ED repeated visits (82.6%) occurred in patients not referred to headache center at discharge from first ED visit. The most frequent diagnosis was primary headache; viral illnesses represented the majority of secondary headaches. Underlying serious disorders were associated with neurological signs, limiting the need of diagnostic investigations. Well structured prospective studies are needed to evaluate appropriate diagnostic tools, as well as correct therapeutic approach of pediatric headache in emergency. Collaboration with headache center might limit repeated visits and provide a correct diagnostic definition.
