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Clinical categorization of 312 children with chronic headache
Y Nevo1, U Kramer, I Rieder-Groswasser
1Institute for Child Development, Tel Aviv, Israel.
Insights
Chronic headaches in children are usually benign. Most cases diagnosed with migraine or tension-type headache, and neuroimaging is often unnecessary when no neurological symptoms are present.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Clinical Pediatrics
Background:
- Chronic headache is a common reason for pediatric neurology referrals.
- Understanding the prevalence and types of chronic headaches in children is crucial for accurate diagnosis and management.
- Distinguishing between primary and secondary headaches guides clinical decision-making.
Purpose of the Study:
- To investigate the characteristics and diagnoses of chronic headaches in children.
- To determine the incidence of different headache types, including migraine and tension-type headache.
- To assess the necessity of neuroimaging in pediatric chronic headache cases without neurological deficits.
Main Methods:
- Retrospective review of 312 children with headaches lasting over 3 months.
- Analysis of patient demographics, headache history, and diagnostic findings.
- Evaluation of electroencephalogram (EEG) and computerized tomography (CT) scan results where available.
Main Results:
- Migraine diagnosed in 54% and tension-type headache in 22% of pediatric patients.
- Common migraine was most prevalent (85%); classic and complicated migraine were less frequent.
- A subgroup with brief headaches showed high epileptic EEG activity; CT scans were largely unremarkable.
Conclusions:
- Chronic and recurrent headaches in children, without neurological symptoms, are typically benign.
- Neuroimaging is generally not indicated for these common pediatric headaches.
- Further investigation may be warranted for children presenting with brief, episodic headaches suggestive of epilepsy.
Abstract:
Three hundred and twelve children referred to an outpatient pediatric neurology clinic, with headache that lasted more than 3 months, were retrospectively reviewed. On average, the age of pain onset was 8.4 years. Migraine was diagnosed in 54% of these children and tension-type headache was found in 22% of those with chronic headache. Most children (85%) had common migraine, while classic and complicated migraine was found in only 8.8% and 5.3%, respectively. Brief headaches, lasting from seconds to a few minutes, were found in 5.1% of the children evaluated. In this subgroup, a high rate of epileptic EEG activity was found. Out of 110 children who had undergone computerized tomography, only one was pathological (posterior arachnoid cyst). Our results indicate that chronic and recurrent headache without accompanying neurological symptoms are usually benign and therefore in most cases neuroimaging is not indicated.