The Role of Neuroimaging in Children and Adolescents With Recurrent Headaches

From Headache

Young-Il Rho, MD; Hee-Jung Chung, MD; Eun-Sook Suh, MD; Kon-Hee Lee, MD; Baik-Lin Eun, MD; Sang-Ook Nam, MD;Won-Seop Kim, MD; So-Hee Eun, MD; Young-Ok Kim, MD

Posted: 03/24/2011; Headache. 2011;51(3):403-408. © 2011 Blackwell Publishing

Abstract

Objectives.
To evaluate the role of neuroimaging and to estimate the prevalence of significant and treatable intracranial lesions in children and adolescents with recurrent headaches.

Background.
Neuroimaging studies are commonly performed in children and adolescent patients with headache because of increasing demands by parents and physicians, although objective data and studies to support this widespread practice are minimal.

Methods.
We retrospectively reviewed the medical records of all 1562 (male 724, female 838) new patients presenting with recurrent headaches to 9 Pediatric Neurology Clinics of tertiary Hospitals. Data regarding age of onset, duration of symptoms before presentation, frequency, duration of each episode, intensity, location and quality of headache, associated neurologic symptoms and a comprehensive neurological examination were obtained for each patient.
The International Classification of Headache Disorders, second edition, was used to classify headache types.

Results.
Neuroimaging procedures were performed in 77.1% of the patients.Overall, 9.3% (112/1204) of the patients had abnormal findings from neuroimaging.
The highest yield was in patients with an abnormal neurological examination wherein abnormal findings on neuroimaging were seen in 50.0% (9/18) of patients (P < .001). The yield was low when imaging was carried out in view of changes in the type of headache (12.9% [26/201]), neurologic dysfunction (10.8% [9/83]), recent onset of severe headaches (7.0% [12/171]), and demands of parent and physicians (10.1% [21/208]). Eleven patients underwent surgery based on neuroimaging results. There was no significant relation between abnormality on neuroimaging and age, sex, headache type, age of onset of headache, duration of symptoms before presentation, duration, frequency, location and intensity of headache (P > .05).

Conclusions.
Neuroimaging procedures in children and adolescents with headaches, although not always required, are very commonly performed. We suggest that more strict guidelines for rational use of neuroimaging are needed for pediatric headache patients.

Introduction

Although most headaches in children and adolescents are because of benign conditions such as migraine and tension-type headache,parents and physicians are concerned about serious underlying diseases such as brain tumor.
The etiology of headaches can most often be determined by a thorough and precise history and a comprehensive neurologic examination.
Neuroimaging (computed tomography [CT] or magnetic resonance imaging [MRI]) is rarely necessary unless the history or neurologic examination suggests structural etiologies.

Several reports in the literature have assessed the utility of neuroimaging in children and adolescents with headaches.
The results of these studies are varied because most assessed the utility of neuroimaging in various forms of headache in children and in different populations. Therefore, the results of these studies may not reflect the whole group.
The neuroimaging evaluation guidelines for pediatric patients with recurrent headaches were addressed by the American Academy of Neurology based on data available from 6 pediatric studies, and in the report of the US Headache Consortium in 2002.Since then, only a few studies have been reported.

The incidence of brain tumors and sinister intracranial disorders among children with headaches, which are significant concerns to physicians and parents, are very low.
Nevertheless, neuroimaging studies are frequently performed in clinical practice because of the fear of missing serious underlying diseases, increasing parental demands, and the enforcement of clinicians practicing defensive medicine because of the increase in malpractice lawsuits.

This study was performed to evaluate the utility of neuroimaging.
In addition, it was performed to estimate the prevalence of significant and treatable intracranial lesions in children and adolescents with recurrent headaches in the pediatric neurologic clinic of tertiary hospitals.

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