- by Dr Gowher Yusuf
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- Aug 18 2017
Neuro-imaging in Children with Recurrent Headaches: Comments
(Source: Headache. 2011; 51(3):403-408. © 2011 Blackwell Publishing)
The primary reason to obtain a neuro-imaging study is the detection of significant and treatable lesions that can be life-threatening and impact quality of life. However, the incidence of brain tumor and sinister intracranial disorders among children and adolescents with headaches are very low. Secondary headaches with an underlying pathology are far less common. Headache as a result of a space-occupying lesion is very rarely an isolated symptom.
Approximately 1 in 10 children with brain tumors presents with headache as their only symptom and has a normal physical examination leading to a delayed diagnosis. There are potential risks with neuro-imaging, including allergic reactions to iodine contrast media, over sedation in younger children, radiation exposure, false positive results, and false reassurance. Nevertheless, neuro-imaging studies are frequently performed because of increasing parental demands and the enforcement of clinicians practicing defensive medicine.
Practice parameters for the evaluation of children and adolescents with recurrent headaches recommend that diagnostic neuro-imaging be considered for children with an abnormal neurologic examination or other historical features that suggest neurologic dysfunction. These recommendations emphasized that obtaining a neuro-imaging study on a routine basis is not indicated for children with recurrent headache and a normal neurologic examination.
In one study, 5 predictive variables that helped distinguish patients with space-occupying lesions from those without such lesions were determined. These included headaches of less than 1 month in duration, absence of a family history of migraine, abnormal neurologic findings on examination, gait abnormalities, and occurrence of seizures.
To conclude, neuro-imaging procedures are very commonly performed in children and adolescents with recurrent headaches that are rarely because of serious intracranial pathology. We suggest that a careful history and a comprehensive neurological examination will identify most patients with serious underlying brain abnormalities. An abnormal neurologic examination is the strongest predictive factor for serious intracranial lesions.
Education of parents regarding the role of neuro-imaging, mitigating false beliefs about headaches and increasing physicians' awareness regarding the utility of practice guidelines and the risk of neuro-imaging procedures are needed to curb neuro-imaging overuse. Surgical treatment was not needed in any case undergoing neuro-imaging because of reasons of change in the type of headache and demands of parents or physicians.
We suggest that neuro-imaging study should remove "change in the type of headache" from the official guidelines in children. Well-controlled prospective studies are needed to confirm our result and to better understand the significant differences in sensitivities between MRI and CT neuro-imaging for patients with recurrent headaches in children and adolescents.
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