Abstract
Headache is a common complaint in children, one that gives rise to considerable parental concern and fear of the presence of a space-occupying lesion. The evaluation and diagnosis of headache is very challenging for paediatricians, and neuroimaging by means of CT or MRI is often requested as part of the investigation. CT exposes children to radiation, while MRI is costly and sometimes requires sedation or general anaesthesia, especially in children younger than 6 years. This review of the literature on the value of neuroimaging in children with headache showed that the rate of pathological findings is generally low. Imaging findings that led to a change in patient management were in almost all cases reported in children with abnormal signs on neurological examination. Neuroimaging should be limited to children with a suspicious clinical history, abnormal neurological findings or other physical signs suggestive of intracranial pathology. Well-designed prospective studies are needed to better define the clinical findings that warrant neuroimaging in children with headache.
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Arafeh I, Razak S, Sivaraman B et al (2010) Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies. Dev Med Child Neurol 52:1088–1097
Lewis DW, Ashwal S, Dahl G et al (2002) 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 59:490–498
Bauchet L, Rigau V, Mathieu-Daudé H et al (2009) Clinical epidemiology for childhood primary central nervous system tumors. J Neurooncol 92:87–98
Bleyer WA (1999) Epidemiologic impact of children with brain tumors. Childs Nerv Syst 15:758–763
Schwedt TJ, Guo Y, Rothner AD (2006) “Benign” imaging abnormalities in children and adolescents with headache. Headache 46:387–398
King MA, Kanal KM, Relyea-Chew A et al (2009) Radiation exposure from pediatric head CT: a bi-institutional study. Pediatr Radiol 39:1059–1065
Pearce MS, Salotti JA, Little MP et al (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380:499–505
Pearce MS, Salotti JA, McHugh K et al (2011) CT scans in young people in Northern England: trends and patterns 1993–2002. Pediatr Radiol 41:832–838
McHugh K, Disini L (2011) Commentary: for the children’s sake, avoid non-contrast CT. Cancer Imaging 11:16–18
Medina LS, Pinter JD, Zurakowski D et al (1997) Children with headache: clinical predictors of surgical space-occupying lesions and the role of neuroimaging. Radiology 202:819–824
Hicks CW, Weber JG, Reid JR et al (2011) Identifying and managing intracranial complications of sinusitis in children: a retrospective series. Pediatr Infect Dis J 30:222–226
Adame N, Hedlund G, Byington CL (2005) Sinogenic intracranial empyema in children. Pediatrics 116:e461–e467
Ghosh PS, Ghosh D, Goldfarb J et al (2011) Lateral sinus thrombosis associated with mastoiditis and otitis media in children: a retrospective chart review and review of the literature. J Child Neurol 26:1000–1004
Tepper DE, Tepper SJ, Sheftell FD et al (2007) Headache attributed to hypothyroidism. Curr Pain Headache Rep 11:304–309
Alexiou GA, Sfakianos G, Prodromou N (2010) Intracranial dermoid cysts in children. Arch Argent Pediatr 108:191–192
Dörner L, Fritsch MJ, Stark AM et al (2007) Posterior fossa tumors in children: how long does it take to establish the diagnosis? Childs Nerv Syst 23:887–890
Alexiou GA, Prodromou N (2009) Torticollis as an initial sign of Chiari I malformation. Pediatr Emerg Care 25:215
Alehan FK (2002) Value of neuroimaging in the evaluation of neurologically normal children with recurrent headache. J Child Neurol 17:807–809
Abu-Arafeh I, Macleod S (2005) Serious neurological disorders in children with chronic headache. Arch Dis Child 90:937–940
Rossi LN, Vassella F (1989) Headache in children with brain tumors. Childs Nerv Syst 5:307–309
Olesen J (2004) The International Classification of Headache Disorders, 2nd edition. Cephalalgia 24(Suppl 1):9–160
Laurell K, Larsson B, Eeg-Olofsson O (2004) Prevalence of headache in Swedish schoolchildren, with a focus on tension-type headache. Cephalalgia 24:380–388
Lipton RB, Silberstein SD, Stewart WF (1994) An update on the epidemiology of migraine. Headache 34:319–328
Lipton RB, Manack A, Ricci JA et al (2011) Prevalence and burden of chronic migraine in adolescents: results of the chronic daily headache in adolescents study (C-dAS). Headache 1:693–706
Lewis DW, Dorbad D (2000) The utility of neuroimaging in the evaluation of children with migraine or chronic daily headache who have normal neurological examinations. Headache 40:629–632
Vernooij MW, Ikram MA, Tanghe HL et al (2007) Incidental findings on brain MRI in the general population. N Engl J Med 357:1821–1828
Parisi P, Papetti L, Spalice A et al (2010) Tension-type headache in paediatric age. Acta Paediatr 100:491–495
Monteith TS, Sprenger T (2010) Tension type headache in adolescence and childhood: where are we now? Curr Pain Headache Rep 14:424–430
Lewis KS (2010) Pediatric headache. Sem Pediatr Neurol 17:224–229
Arruda MA, Bonamico L, Stella C et al (2011) Cluster headache in children and adolescents: ten years of follow-up in three pediatric cases. Cephalalgia 31:1409–1414
Lampl C (2002) Childhood-onset cluster headache. Pediatr Neurol 27:138–140
Seifert TD, Evans RW (2010) Posttraumatic headache: a review. Curr Pain Headache Rep 14:292–298
Wilson MC, Krolczyk SJ (2006) Pediatric post-traumatic headache. Curr Pain Headache Rep 10:387–390
Alexiou GA, Sfakianos G, Prodromou N (2011) Pediatric head trauma. J Emerg Trauma Shock 4:403–408
Kirk C, Nagiub G, Abu-Arafeh I (2008) Chronic post-traumatic headache after head injury in children and adolescents. Dev Med Child Neurol 50:422–425
Lenaerts ME, Couch JR, Couch JR (2004) Posttraumatic headache. Curr Treat Options Neurol 6:507–517
Obermann M, Holle D, Katsarava Z (2009) Post-traumatic headache. Expert Rev Neurother 9:1361–1370
Zafonte RD, Horn LJ (1999) Clinical assessment of posttraumatic headaches. J Head Trauma Rehabil 14:22–33
Tubbs RS, Beckman J, Naftel RP et al (2011) Institutional experience with 500 cases of surgically treated pediatric Chiari malformation type I. J Neurosurg Pediatr 7:248–526
Alexiou GA, Varela M, Sfakianos G et al (2010) Shunting for the treatment of arachnoid cysts in children. Neurosurgery 67:1632–1636
Conicella E, Raucci U, Vanacore N et al (2008) The child with headache in a pediatric emergency department. Headache 48:1005–1011
Streibert PF, Piroth W, Mansour M et al (2011) Magnetic resonance imaging of the brain in children with headache: the clinical relevance with modern acquisition techniques. Clin Pediatr 50:1134–1139
Maytal J, Bienkowski RS, Patel M et al (1995) The value of brain imaging in children with headaches. Pediatrics 96:413–416
Rho YI, Chung HJ, Suh ES et al (2011) The role of neuroimaging in children and adolescents with recurrent headaches—multicenter study. Headache 51:403–408
Dooley JM, Camfield PR, O’Neill M et al (1990) The value of CT scans for children with headaches. Can J Neurol Sci 17:309–310
Wöber-Bingöl C, Wöber C, Prayer D et al (1996) Magnetic resonance imaging for recurrent headache in childhood and adolescence. Headache 36:83–90
Chu ML, Shinnar S (1992) Headaches in children younger than 7 years of age. Arch Neurol 49:79–82
Ahmed MA, Martinez A, Cahill D et al (2010) When to image neurologically normal children with headaches: development of a decision rule. Acta Paediatr 99:940–943
Graf WD, Kayyali HR, Alexander JJ et al (2008) Neuroimaging-use trends in nonacute pediatric headache before and after clinical practice parameters. Pediatrics 122:e1001–e1005
Lateef TM, Grewal M, McClintock W et al (2009) Headache in young children in the emergency department: use of computed tomography. Pediatrics 124:e12–e17
Romero Sánchez J, Picazo Angelín B, Tapia Ceballos L et al (1998) Effectiveness of brain imaging in children with headache. An Esp Pediatr 49:487–490
Chan TY, Wong V (2006) Recurrent headache in Chinese children: any agreement between clinician diagnosis and symptom-based diagnoses using the International Classification of Headache Disorders (Second Edition)? J Child Neurol 21:132–138
Seshia SS (2004) Chronic daily headache in children and adolescents. Can J Neurol Sci 31:319–323
Strain JD (2007) ACR appropriateness criteria on headache-child. J Am Coll Radiol 4:18–23
Branson HM, Doria AS, Moineddin R et al (2007) The brain in children: is contrast enhancement really needed after obtaining normal unenhanced CT results? Radiology 244:838–844
Colosimo C, Demaerel P, Tortori-Donati P et al (2005) Comparison of gadobenate dimeglumine (Gd-BOPTA) with gadopentetate dimeglumine (Gd-DTPA) for enhanced MR imaging of brain and spine tumours in children. Pediatr Radiol 35:501–510
Dillman JR, Ellis JH, Cohan RH et al (2007) Frequency and severity of acute allergic-like reactions to gadolinium-containing i.v. contrast media in children and adults. AJR Am J Roentgenol 189:1533–1538
Petrou M, Foerster B, Maly PV et al (2007) Added utility of gadolinium in the magnetic resonance imaging (MRI) workup of seizures in children younger than 2 years. J Child Neurol 22:200–203
Foerster BR, Ksar J, Petrou M et al (2006) Value of gadolinium in brain MRI examinations for developmental delay. Pediatr Neurol 35:126–130
Eldevik OP, Brunberg JA (1994) Gadopentetate dimeglumine-enhanced MR of the brain: clinical utility and safety in patients younger than two years of age. AJNR Am J Neuroradiol 15:1001–1008
Sundgren PC, Leander P (2011) Is administration of gadolinium-based contrast media to pregnant women and small children justified? J Magn Reson Imaging 34:750–757
Emond S, Brunelle F (2011) Gd-DOTA administration at MRI in children younger than 18 months of age: immediate adverse reactions. Pediatr Radiol 41:1401–1406
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Alexiou, G.A., Argyropoulou, M.I. Neuroimaging in childhood headache: a systematic review. Pediatr Radiol 43, 777–784 (2013). https://doi.org/10.1007/s00247-013-2692-3
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DOI: https://doi.org/10.1007/s00247-013-2692-3