Diagnosis and Treatment of Headache in a Pediatric Emergency Department
Francisca M Costa1, Inês P Ferreira, Inês F Mascarenhas
1From the Hospital Professor Doutor Fernando da Fonseca, EPE. Lisbon, Portugal.
Insights
This study analyzed pediatric emergency department visits for headaches, finding benign causes were most common. Antiemetics showed promise for primary headaches, but alternative treatments are needed for severe pain.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Clinical Management
Background:
- Headaches are a common complaint in pediatric emergency departments.
- Understanding the etiology and treatment of pediatric headaches is crucial for effective clinical management.
Purpose of the Study:
- To analyze the causes and clinical management of headaches in children presenting to the emergency department.
- To evaluate treatments for children diagnosed with headaches and migraines.
Main Methods:
- Retrospective study of pediatric patients with headache as a chief complaint or primary diagnosis.
- Data collected from a single hospital's emergency department in 2014.
Main Results:
- Headache-related visits constituted 3.8% of all emergency visits, with 2354 subjects.
- Common diagnoses included headaches (21.3%), upper respiratory infections (18.4%), and migraines (6.1%).
- Ondansetron use was associated with fewer revisits, while acetaminophen or no medication for mild-moderate pain correlated with more revisits.
Conclusions:
- Most pediatric headaches in the emergency department are secondary and benign, rarely indicating life-threatening conditions.
- Antiemetics may be effective for primary headaches, but alternative treatments are necessary for severe pain.
- Further research into optimal pain management strategies for pediatric headaches is warranted.
Objectives:
The aims of the study were (1) to analyze the etiology and clinical management of headaches in children in the emergency department and (2) to analyze the treatment used in children diagnosed with headaches and with migraines.
Methods:
Retrospective study of all the patients who were admitted to the pediatric emergency department of Hospital Professor Doutor Fernando Fonseca, Lisbon, in 2014, with a chief complaint of headaches or the primary discharge diagnosis was headache/migraine.
Results:
Headache related cases represented 3.8% of all the visits, a total of 2354 subjects. The median age was 10 years and 52.6% were female. The most frequent diagnoses were as follow: headaches (21.3%), upper respiratory infections (18.4%), and migraines (6.1%). There were 4 cases of meningitis, 6,5% of all patients underwent computed tomography which was mostly requested in school-age children and adolescents. The average time from the first medical observation until discharge was 85 minutes. Fifty-five percent did not take any pain relief medication, 17.2% took acetaminophen, and 11.1% took ibuprofen. Patients who received ondansetron had less revisits (P = 0.000). Subjects with mild-moderate pain treated with acetaminophen or no medication had more revisits (P = 0.000).
Conclusions:
Secondary benign headaches were the most common and very rarely headache as a symptom was associated with life-threatening situations. Antiemetics seem to be efficient ally in the treatment of primary headaches, but it is important to consider alternative pharmacological regimes in patients who present with higher pain scores.
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