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Published on: June 2, 2014
Site locked headaches in paediatric patients do not require routine brain imaging and rarely have a serious aetiology
Mas Ahmed1, S Grossman2, B Rafique1
1Paediatric Department, Queen's University Hospital, Essex, UK.
Insights
Site locked headaches (SLH) in children are most commonly caused by primary headaches like migraine. In most cases, SLH without neurological abnormalities do not indicate serious underlying conditions, making routine brain imaging unnecessary.
Area of Science:
- Pediatric Neurology
- Headache Medicine
Background:
- Site locked headaches (SLH) are a specific type of headache in children.
- Understanding the causes and diagnostic yield of brain imaging for SLH is crucial for appropriate clinical management.
Purpose of the Study:
- To investigate the aetiology of site locked headaches in children.
- To determine the diagnostic value of brain imaging in children presenting with SLH.
Main Methods:
- Prospective data collection from patients aged 5-17 years with at least five SLH attacks and normal neurological exams.
- Exclusion of bilateral or alternating unilateral headaches.
- Diagnosis based on the International Classification of Headache Disorders.
Main Results:
- 292 children were identified, with unilateral SLH being most common (n=177).
- Migraine was the most frequent diagnosis (n=192), followed by tension-type headaches (n=30).
- Brain imaging (MRI) was normal in 96% of scanned patients, with 4% showing nonspecific abnormalities.
Conclusions:
- Primary headaches, especially migraine, are the most likely cause of SLH in children.
- SLH in children without neurological deficits typically have a benign aetiology.
- Routine brain imaging is generally not indicated for children with SLH and normal neurological examinations.
Aim:
The main aim of this study was to examine the aetiology and the yield of brain imaging of children with site locked headaches (SLH).
Methods:
This study was carried out at Queen's University Hospital, Essex, UK, from August 2011 to August 2015 and focused on patients who were at least five years of age, had experienced at least five SLH attacks and had a normal neurological examination. Bilateral or alternating unilateral headaches were excluded. Data were collected prospectively, and the headache diagnosis was based on the International Classification of Headache Disorders.
Results:
We identified 292 eligible patients (60% female) aged 5.1-17 years: 177 with unilateral SLH, 104 with occipital SLH and 11 with vertex SLH. Anterior headaches were the most frequent (n = 133), and the diagnoses included migraine (n = 192), tension type headaches (n = 30) and medication-overuse headaches (n = 22). The headache was unspecified in 43 cases. Magnetic resonance imaging was normal in 96% of the 283/292 scanned or showed a nonspecific, nonsignificant abnormality in 4%.
Conclusion:
Site locked headaches were most likely to be caused by primary headaches, particularly migraine. An SLH without abnormal neurological findings is unlikely to have an underlying sinister aetiology, and routine brain imaging is not required in such cases.
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