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Brain imaging in children referred to pediatric neurology out-patients with headache
Emine Ergül Sarı1, Gonca Bektaş2, Figen Palabıyik3
1Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Pediatrics, Istanbul, Turkey.
Insights
Brain MRI scans rarely reveal significant issues in children experiencing chronic headaches and normal neurological exams. Imaging is most useful for specific, selected pediatric headache cases.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Child Health
Background:
- Headaches are prevalent in children and adolescents.
- Intracranial pathology is a primary concern for pediatric headaches.
- Brain imaging is frequently employed for diagnosis.
Purpose of the Study:
- To evaluate the diagnostic yield of brain magnetic resonance imaging (MRI) in children with chronic headaches.
- To determine the frequency of significant intracranial abnormalities in this population.
Main Methods:
- Retrospective analysis of pediatric neurology outpatient records (June-December 2018).
- Inclusion criteria: children aged 2-17 with headaches >4 weeks duration.
- Brain MRI findings were categorized based on clinical significance.
Main Results:
- 387 children (median age 10.5 years; 234 female) were analyzed.
- Median headache duration was 12 months.
- 65% of brain MRIs were normal; 20% showed possibly related abnormalities; 14% showed unrelated abnormalities requiring no intervention; 0.3% showed abnormalities requiring intervention.
Conclusions:
- Brain MRI has a low probability of detecting significant abnormalities in children with chronic headaches and normal neurological exams.
- Imaging can be valuable for diagnosing specific pediatric headache cases.
Objective:
Headaches are common in children and adolescents as well as in adults. Due to the fact that the primary medical concern for children presenting with headache complaints is the possibility of intracranial pathology, nowadays, imaging methods are frequently used in those patients.
Methods:
Retrospective data analysis was performed on the records of children who attended the Pediatric Neurology Outpatient Clinic between June 01, 2018, and December 01, 2018, complaining of headaches. Children who had a headache for longer than four weeks and had brain magnetic resonance imaging were included in the study. Brain MRI findings were classified as (1) headache-related and requiring definitive intervention, (2) possibly headache-related abnormalities, (3) headache-related abnormalities that did not require intervention, and (4) normal.
Results:
The 387 patients included in the study were between the ages of 2 and 17, with a median age of 10.5 years. Of the patients, 234 were female and 153 were male. The duration of the headache was a median of 12 months. According to brain MRI findings, 253 patients (65%) were in group 4, 79 patients (20%) were in group 2, 54 patients (14%) were in group 3, and 1 patient (0.3%) was in group 1.
Conclusion:
The probability of detecting significant abnormalities with brain MRI in children with chronic headaches with normal neurological examination is found to be low. Imaging methods should be kept in mind that they may be useful in diagnosis in selected cases.
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