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Headache in the pediatric emergency department: A 5-year retrospective study
Roberta Rossi1, Antonia Versace1, Barbara Lauria1
11 A.O.U. Città della Salute e della Scienza di Torino, Regina Margherita Children's Hospital, Department of Pediatric Emergency, Pediatric Headache Centre, Turin, Italy.
Insights
Serious pediatric headaches are rare, with specific red flags like cranial nerve palsy guiding diagnosis. Collaboration with a Headache Centre can reduce emergency department visits for children with non-traumatic headaches.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Clinical Diagnostics
Background:
- Headaches are a common reason for pediatric emergency department visits.
- Distinguishing benign headaches from serious organic causes is crucial for appropriate management.
- Understanding red flags and optimizing follow-up care can improve patient outcomes and resource utilization.
Purpose of the Study:
- To identify clinical red flags for serious organic causes of headache in children.
- To evaluate the appropriateness of headache management in pediatric emergency departments.
- To assess the effectiveness of follow-up care in reducing recurrent emergency department visits.
Main Methods:
- Retrospective review of patients aged 18 years or younger presenting with non-traumatic headache over five years.
- Screening of patients followed up by a dedicated Pediatric Headache Centre.
- Statistical analysis including Chi-squared test, Fisher's exact test, and multivariate analysis (p < 0.05 significance).
Main Results:
- 1833 patients (54.6% males) made 2086 visits; 62.1% had primary headaches, 30.0% secondary.
- Serious disorders were diagnosed in 24 patients (1.1% of visits), with red flags including cranial nerve palsy, strabismus, and drowsiness.
- Neuroimaging was performed in 8.8% of patients, with a 7.1% pathological finding rate; pain management was insufficient in 37.2%.
Conclusions:
- The majority of pediatric headaches presenting to emergency departments are benign.
- Serious headaches are rare and associated with specific clinical red flags and neurological findings, guiding appropriate neuroimaging.
- Enhanced collaboration with Headache Centres is vital for reducing repeat emergency department visits and improving care.
Abstract:
Aim To determine the red flags for serious organic causes of headache in children, to analyze if the management of headache in the Pediatric Emergency Department is appropriate, and whether the follow-up may limit repeated visits to the Emergency Department. Methods All the patients ≤ 18 years referred to our pediatric Emergency Department for non-traumatic headache over 5 years were retrospectively reviewed. The patients followed up by the Pediatric Headache Centre were also screened. Statistical analysis was undertaken using the Chi-squared test or Fisher's exact test and multivariate analysis; significance at p < 0.05. Results 1833 patients (54.6% males) accessed our Emergency Department 2086 times; 62.1% had primary headache, 30.0% had secondary headache, 7.8% received inconsistent diagnosis. Among those with secondary headache, 24 (1.1% of total visits) were diagnosed with serious disorders. The clinical red flags for "serious headache" were: Cranial nerves palsy, strabismus, and drowsiness. One hundred and eighty four patients (8.8 %) underwent neuroimaging (rate of pathological findings: 7.1 %); 37.2 % of the patients received analgesic therapy. One hundred and fifteen patients (6.2 %) returned within three months; 24 of these were referred to the Headache Centre, with only one accessing the Emergency Department again. Conclusions The vast majority of headaches referred to the Pediatric Emergency Department are benign, and primary forms prevail. "Serious headache" is rare and shows typical clinical features and abnormal neurologic evaluation; specific clinical red flags, along with suggestive personal history, should lead the pediatrician to prescribe only appropriate neuroimaging. Pain relief is still insufficient in the Pediatric Emergency Department despite appropriate guidelines. Last, the collaboration with the Headache Centre is crucial to limit repeated visits.
