Abstract
High resolution imaging modalities and electroencephalographic studies (EEG) are used in the assessment of children with headaches. We evaluated the role of cerebral MRI (cMRI) and EEG in the initial assessment of children with headache as the chief complaint of initial presentation. A retrospective chart analysis was performed at a tertiary University Hospital. 209 patients were included in this study [mean age 11.3 years; male 91 (43.5%); female 118 (56.5%)]. The following types of headaches were seen: Unclassified headache: 23.4%; probable migraine 17.2%, migraine without aura 13.4%, complicated migraine 12.4%, migraine with aura 1.0%; tension-type 15.3%, and cluster headaches 0.5%, and secondary headaches 16.7%. In 93 children (44.5%) abnormal physical/neurological findings were noted (multiple entries possible). On cMRI studies the following findings were seen: Infection of sinuses (7.2%), pineal cysts (2.4%), arachnoidial cyst and Chiari malformation (1.9%), unspecified signal enhancement (1.0%), and pituitary enlargement, inflammatory lesion, angioma, cerebral ischaemia, and intra-cerebral cyst (each 0.5%). Electroencephalographic findings included both focal and generalised abnormal slowing (5.3%) and Spike-wave complexes (3.3%). Despite abnormal findings on neurological/physical examination in a substantial number of children with headaches, the yield of pathological cMRIs was low. The use of EEG recordings was not contributory to the diagnostic and therapeutic approach. More research is needed to better define those patients who are likely to have an intracranial pathology.
Highlights
Headache is a common problem in children and adolescents affecting some 59% of boys and 84% of girls within the age group of 13–19 years [1]
We evaluated the role of cerebral magnet resonance imaging (MRI) and EEG in the initial assessment of children with headache as the chief complaint of initial presentation
During the time period 1 January 2001 to 31 December 2009 a total of 818 patients seen in our hospital with a history of headache were entered in our hospital database
Summary
Headache is a common problem in children and adolescents affecting some 59% of boys and 84% of girls within the age group of 13–19 years [1]. While there is considerable parental concern that headache in their children is caused by an intra-cerebral space-occupying process, in reality, this is only rarely the case. Previous reports have stressed the importance of a carefully taken history, and a thorough physical examination rather than any testing in the initial assessment of children with headaches [2]. Imaging studies (cMRI and cCT) as well as neurophysiological studies (electroencephalogram = EEG) are commonly requested diagnostic tests when children and adolescents present with headaches [3, 4]. The aim of this study was to generate up-to-date data on the role of cMRI and EEG studies in the initial evaluation of children and adolescents with headaches. We correlated risk factors as described by the Subcommittee of the American Academy of Neurology and the Pediatric Committee of Child Neurology Society with abnormal findings (space-occupying lesions) with findings of cMRI studies [5]
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