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Delayed diagnosis in pediatric headache: an outpatient Italian survey
Bruno Colombo1, Dacia Dalla Libera, Donatella De Feo
1Department of Neurology, Headache Center, INSPE, San Raffaele Hospital Scientific Institute, Vita-Salute University, Milano, Italy.
Insights
Pediatric headache diagnosis is often delayed, with a median of 20 months from symptom onset. Early diagnosis and awareness are crucial for effective treatment in children experiencing recurrent headaches.
Area of Science:
- Pediatric Neurology
- Headache Medicine
Background:
- Recurrent headaches in children are a significant concern, often leading to delayed diagnosis and treatment.
- Under-diagnosis and under-estimation of pediatric headache as a health issue persist in both medical and social contexts.
Purpose of the Study:
- To evaluate the time interval between the onset of recurrent headaches and accurate diagnosis in pediatric patients.
- To identify factors contributing to diagnostic delays in children with headaches.
Main Methods:
- A prospective study involving 101 pediatric patients and their parents at an Italian children's headache center.
- Semi-structured interviews were conducted to gather data on headache history, previous evaluations, and treatments.
- Patients were evaluated by expert neurologists and diagnosed using the International Classification of Headache Disorders II (2004).
Main Results:
- The median diagnostic delay was 20 months, with younger age, positive family history, and female gender associated with longer delays.
- A significant proportion of patients (21%) were previously misdiagnosed, leading to extended diagnostic timelines.
- Only 76 out of 101 patients received an appropriate diagnosis at the time of the study visit.
Conclusions:
- Pediatric headache remains under-diagnosed and inadequately recognized as a health problem.
- Educational initiatives targeting healthcare professionals and the general population are necessary to improve awareness and timely diagnosis.
- Enhanced awareness and accurate diagnosis are essential for appropriate and effective management of pediatric headaches.
Objective:
The aim of this prospective study is to assess the time lapse between the onset of recurring headache and the correct diagnosis in a cohort of pediatric patients attending an Italian children's headache center for the first time.
Methods:
One hundred and one patients and parents, referred to the Pediatric Headache Centre of San Raffaele Hospital in Milan, Italy, underwent a semi-structured interview to ascertain features of headache since onset (clinical and family history, presence of childhood periodic syndromes, previously undergone instrumental exams and specialists' examinations before the correct diagnosis, past and current treatment). All patients were evaluated by expert neurologists and their headache was classified according to the International Classification of Headache Disorders II (2004).
Results:
The median time delay from the onset of the first episode of recurrent headache to definite diagnosis was 20 months (interquartile range 12 to 36 months). A correlation with younger age and a more delayed headache diagnosis was found (r Spearman = 0.25; P = .039). An association between diagnostic delay and positive family history (median 24 months [12 to 48] vs 12 [6 to 24]; P = .014) or female gender (median 18 months [12 to 42] vs. 12 [5 to 30]; P trend = .070) was also evident. Notably, 76 out of 101 patients referred to our Center received an appropriate diagnosis according to International Classification of Headache Disorders II at the time of our visit only. Of note, up to 21% of this group were previously misdiagnosed (for epilepsy 43%, sinusitis 38%, or other diseases 19%), a fact that contributed to a longer time of clinical assessment (median 39 months) before reaching a correct diagnosis. The other group of 80 patients (79%) did not receive a specific diagnosis and treatment, and were not studied until their symptom became chronic and disabling.
Conclusion:
Pediatric headache is still under-diagnosed and not adequately considered as a health problem in the medical community as well as social settings. There is a need for educational programs regarding headache involving not only general practitioners, pediatricians, and neurologists, but also the general population. These are desirable in order to raise awareness of such a condition and, accordingly, treat children accurately.
