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[A retrospective study of infant headache]
S Sánchez-Precioso1, E García-Cantó, O Villaescusa
1Servicio de Neuropediatria, Hospital Infantil La Fe, Valencia.
Insights
Pediatric headaches requiring hospitalization are common. Migraine is the most frequent diagnosis, and routine brain CT scans may not be cost-effective for children without neurological signs.
Area of Science:
- Pediatric Neurology
- Clinical Epidemiology
Context:
- Headache is a common reason for pediatric medical consultation and hospitalization.
- This study focuses on children and adolescents aged 3-13 experiencing headaches severe enough for hospitalization.
Purpose:
- To determine the incidence, epidemiology, clinical features, and etiology of headaches in hospitalized children.
- To evaluate the utility of diagnostic examinations performed during hospitalization.
Summary:
- The study reviewed 94 cases, finding most patients were over seven, with symptoms evolving rapidly, and a high incidence of family history of migraine (58.5%).
- Common symptoms included vomiting (38.2%) and nausea (22.3%). While 17% showed signs of increased intracranial pressure or neurological deficits, 67% had normal physical exams.
- Migraine was the most frequent diagnosis (52%). Electroencephalography was abnormal in 25%, and brain CT scans revealed space-occupying lesions in only 3.2% of cases.
Impact:
- Findings question the routine use of brain CT scans in pediatric headache patients lacking focal neurological signs or signs of increased intracranial pressure.
- Highlights the diagnostic yield of clinical evaluation and suggests a more targeted approach to neuroimaging in pediatric headache management.
Abstract:
Headache either as an isolated syndrome or as part of a symptomatic grouping is a frequent reason for medical consultation or hospitalization during childhood and adolescence. We review 94 clinical histories of patients between three and thirteen years of age. Headache was the reason for being hospitalized in all cases. Our aim was to assess its incidence rate, epidemiology, clinical characteristics and etiology in addition to evaluating as to whether complementary examinations carried out during hospitalization were worthwhile. Among the most significant results were the following: age (73 patients were over seven years old, 77.6%), time elapsed for symptomatology to evolve (exactly or less than one week in 45% of cases); family history of migraine in 55 cases (58.5%). The most frequent accompanying symptoms were vomiting (38.2%), nausea (22.3%) and abdominal pain (19.1%). Physical exam was normal in 63 cases (67%) while sixteen patients (17%) had neurological focal signs and/or signs of endocranial hypertension (ECHT). Electroencephalography was performed on 94.6% of the patients and proved pathological in 22 cases (25%). Brain computerized tomography (CT) scan was carried out on 92.5% of the patients with space occupying lesions in 3.2% of the cases. The most frequent final diagnosis (52% of patients) was one of migraine. We did not find any patients with intracranial expansionary processes not showing signs of ECHT and/or neurological focalization, for which reason we doubt the profitability of the almost routine practice of carrying out brain CT scan on patients when severe headache is the sole symptom and where there are no specific findings during physical examination.(ABSTRACT TRUNCATED AT 250 WORDS)