Magnetic resonance imaging - what important findings can it show in children with headache?

Even though it is not justified to perform computed tomography (CT) and magnetic resonance imaging (MRI) in children with headaches only, these examinations are still performed. As a continuation of a previous work from our centre concerning the value of neuroimaging in the diagnostics of headaches in children, the material was collected from consecutive years and significant neurological abnormalities detected by MRI in those cases are presented.

1000 MR examinations, performed in the years 2007-2012 due to headaches were analysed. In 400 cases MR angiography was performed as an addition to brain scan. The examinations were performed with use of GE Signa HDxt 1.5T scanner according to the routine protocol.

Negative results - no abnormalities - were obtained in 457 children (45.7%). Positive results (in 543 children, 54.3%) were divided into mild (not influencing patient management) and significant (requiring more diagnostic procedures or therapeutic intervention). Significant ear, nose and throat changes were excluded. The percentage of significant neuroradiological changes in the analysed material was 5.6%. Among these there were: brain tumours in 4 children (0.4%), aneurysms in 2 (0.2%), Chiari I malformation in 5 (0.5%), isolated internal hydrocephalus in 6 (0.6%), postischemic scar in 11 (1.1%), hypoplasia of intra- or extracranial arteries in 6 (0.6%), non-specific T2-hyperintense lesions requiring further investigation in 18 (1.8%), cavernous haemangioma in 3 (0.3%), capillary haemangioma in 1 (0.1%).

Rarity of clinically relevant changes in the brain causes that neuroimaging studies should not be routinely carried out in the diagnosis of patients reporting headaches only. If, however, the decision is made to perform them, magnetic resonance imaging should be a method of choice.