PEDIATRIC HEADACHES: DOES NEUROIMAGING CONTRIBUTE TO DIAGNOSIS?

Abstract

Objective
 Headache is a common complaint in childhood.
 While the etiology is usually benign, such as migraine
 or tension-type headache, cranial imaging is often
 performed on patients to identify any missed or serious
 underlying pathology. In the present study we assess
 the etiology and clinical characteristics of headaches
 in children and establish the diagnostic contribution of
 imaging methods.
 Material and Method
 This retrospective study included patients who
 presented with headaches to the Pediatric
 Neurology Outpatient Clinic of Süleyman Demirel
 University Faculty of Medicine between 2019 and
 2022. Headache information (frequency, duration,
 type, characteristics, intensity, localization, and
 accompanying findings) was obtained, and the cranial
 imaging results of patients were recorded. Headaches
 were classified according to the criteria established by
 the International Headache Society.
 Results
 The study included 234 patients aged 2–18 years
 with a mean age of 12.56 years, of which 64.5% were
 female. The diagnosis was primary headaches in
 68.4% of the patients, with tension-type headaches
 in 46.2%, migraine in 31.2%, and other primary
 headache causes in 22.5%. Among the secondary
 headaches, disorders of the cranium, neck, eyes,
 ears, nose, sinuses, teeth or other cervical structures
 accounted for 79.7%, with the most common cause
 being sinusitis. Cranial imaging was performed on
 66.7% of the patients, of which 51.9% were identified
 with abnormal findings. 14.1% of the imaging
 results evaluated as abnormal were incidentally
 detected cerebral abnormalities with potential clinical
 significance; 10.3% were findings that were found
 incidentally and had no clinical significance. The
 treatment of these patients did not change with the
 imaging result. Another 25% were evaluated as
 extracerebral abnormality associated with headache.
 Only one patient's outcome was associated with
 headache. The patient was diagnosed with sinus vein
 thrombosis and the treatment was arranged.
 Conclusion
 The majority of childhood headaches identified in
 the present study were found to be benign, with the
 leading causes being tension-type headache, infection
 and migraine, and imaging methods were found to
 be of little diagnostic benefit. It was concluded that
 a detailed clinical assessment of patients presenting
 with headaches could clarify the etiology, while
 imaging methods may be useful in selected cases.