Neurology| December 01 2002 Practice Parameters for Evaluation of Recurrent Headache AAP Grand Rounds (2002) 8 (6): 67. https://doi.org/10.1542/gr.8-6-67 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Practice Parameters for Evaluation of Recurrent Headache. AAP Grand Rounds December 2002; 8 (6): 67. https://doi.org/10.1542/gr.8-6-67 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: headache Source: Lewis DW, Ashwal S, Dahl G, et al. Practice parameter: evaluation of children and adolescents with recurrent headaches. Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2002;59:490–498. The Quality Standards Subcommittee of the American Academy of Neurology (AAN) and the Practice Committee of the Child Neurology Society (CNS) have developed practice parameters for evaluation of children and adolescents with recurrent headaches. Individual committee members reviewed titles and abstracts for content and relevance. Relevant articles published from 1980 to 2000 were selected using MedLine and Current Contents. All articles selected included case series with more than 25 patients, and which provided information on the details of the patients’ neurologic examination. Those articles dealing with investigations of the etiology of headache were selected for further detailed review. Of those reviewed, only 1 study reported results of laboratory tests and none considered the role of lumbar puncture. Eight studies assessed the use of the electroencephalogram (EEG) in a total of 1,148 children with recurrent headache, but none compared the incidence of EEG abnormalities in migraine versus nonmigraine pediatric headache patients. EEG was not recommended for routine evaluation, even in patients suspected of having seizure-related headaches. Neuroimaging was advised to be considered only in patients with an abnormal neurologic examination or findings suggesting central nervous system disease. Predictors of a spaceoccupying lesion included: 1) recent-onset or change in type of severe headaches; 2) absent family history of migraine; 3) abnormal neurologic exam; 4) gait abnormalities; and 5) seizures. Prospective studies are needed to define the risks for serious intracranial disease associated with recurrent headaches, the role of laboratory tests including indications for lumbar puncture, and the value of neuroimaging in patients with a normal neurologic exam. The AAN and CNS attach a disclaimer recognizing that each patient is an individual with different circumstances and specific diagnostic indications. The committee wisely attached its disclaimer. For example, in deciding on the necessity for neuroimaging, the luxury of follow-up evaluation and observation over time may not be available to the physician who examines a patient in consultation. Deferral of neuroimaging may not always be practical or judicious.1 In particular, headaches in children younger than 4 years may pose a diagnostic problem. In one report, 3 young children had headache as the first symptom of intracranial tumor, and the initial neurologic examination was normal, including the funduscopic exam.2 These authors stress the need for neuroimaging studies in young children with recent-onset recurrent headaches, even when the neurologic exam is normal. Although an EEG is not recommended as a routine test in children with recurrent headache, I believe it is warranted in patients with headache and symptoms suggestive of seizures and in those patients with atypical migraine auras.3 This paper is a useful attempt to summarize a number of studies into a cohesive practice guideline for the management of children with recurrent headaches. It does not... You do not currently have access to this content.
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