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[Effectiveness of brain imaging in children with headache]
J Romero Sánchez1, B Picazo Angelín, L Tapia Ceballos
1Hospital Costa del Sol, Marbella, Málaga.
Insights
Neuroimaging has limited value for diagnosing chronic headaches in children. Most brain scans reveal no significant abnormalities, suggesting reserved use for specific clinical indications.
Area of Science:
- Pediatric Neurology
- Diagnostic Imaging
Background:
- Headache is a frequent pediatric complaint.
- Brain imaging is increasingly utilized for headache evaluation in children.
Purpose of the Study:
- To assess the diagnostic value of neuroimaging in pediatric patients presenting with chronic headaches.
Main Methods:
- Retrospective chart review of 160 children (ages 4-14) evaluated for headache.
- Analysis of headache characteristics, reasons for neuroimaging, and imaging findings, with focus on space-occupying lesions.
Main Results:
- Migraine (60%) and tension headaches (29.5%) were the most common diagnoses.
- Neuroimaging (CT) was performed in 41% of patients, often due to clinical concerns or parental anxiety.
- Only 4 patients had structural changes, none indicating treatable lesions, yielding a maximal abnormality rate of 4.4%.
Conclusions:
- Neuroimaging offers limited clinical value for evaluating chronic headaches in children.
- Its use should be restricted to pediatric cases with specific clinical indicators of underlying structural lesions.
Objective:
Headache is a common complaint in children and brain imaging has become widely used to evaluate this clinical condition. We studied the value of neuroimaging in children with chronic headaches.
Patients And Methods:
A retrospective chart review was conducted of all children referred to the pediatric outpatient clinic for evaluation of headache over a 3-year period. The charts were reviewed for headache characteristics, clinical indications for performing neuroimaging, and imaging results. Special attention was paid to evidence of space-occupying lesions.
Results:
A total of 160 records were studied, with subjects ranging in age from 4 to 14 years. Most patients were diagnosed as having migraine headaches (60%) or chronic tension headaches (29.5%). Other diagnoses were post-traumatic (6%) and unclassified (4%). Sixty-six patients (41%) had computed tomography imaging performed. In most cases, brain imaging studies were performed because of clinical data (41%) like atypical pattern, sleep-related headache or increase of headache, because of the parents' concerns about brain lesions (38%) and because of an age less than 5 years (14%). Structural changes were found on brain imaging in 4 patients, but none indicated the presence of a treatable space-occupying lesion and all were deemed unrelated to the headache. Our findings of no relevant abnormalities in a series of 66 neuroimaging studies indicate that the maximal rate at which such abnormalities might appear in this population is 4.4%.
Conclusions:
These results indicate that neuroimaging studies have very limited value in the clinical evaluation of pediatric patients with chronic headache and should be reserved for those patients with clinical evidence suggestive of underlying structural lesion.
