Purpose of Review The purpose of this review was to summarize the current literature about telemedicine in pediatric headache and to provide practical guidance for its implementation. Recent Findings There are few studies dedicated to telemedicine in pediatric headache, and existing studies are small. Patients and families report high levels of satisfaction with telemedicine, and most are willing to continue telemedicine visits in the future. Telemedicine demonstrated similar reductions in headache frequency, severity, and duration as patients treated in-person. Remotely delivered psychologic interventions have some utility in reducing headache severity acutely. Families feel telemedicine reduces geographic and financial barriers to care. Summary Telemedicine in pediatric headache is a growing field. While there is limited research available, it appears safe, efficacious, and feasible. Headache-related outcomes, including frequency, severity, and duration, were similar amongst telemedicine and in-person visits. Future studies should include larger sample sizes and detailed analysis of adverse outcomes.

Background& Objectives: Neuroimaging is often part of the workup for a pediatric patient presenting with a seizure to an emergency department (ED). We aim to evaluate when neuroimaging in the emergency department for children with a non-first-time seizure, or non-index seizure (NIS), is associated with an acute change in management (ACM).Methods:Retrospective cohort study of all pediatric patients presenting to an ED from 2008-2018 with a NIS, excluding repeat febrile seizures, who underwent neuroimaging. Clinical characteristics were extracted from the electronic medical record. The primary outcome was new abnormal neuroimaging resulting in an ACM, defined as admission to the hospital, neurosurgical intervention, or new non-seizure medication administration.Results:We identified 492 encounters. Neuroimaging revealed new findings in 21% of encounters and led to ACMs in 5% of encounters. ACMs included admissions, neurosurgical interventions, and non-seizure medication changes. Factors associated with ACM included new seizure type (OR 3.3, 95% CI 1.3-8.0), new focal exam finding (OR 3.0, 95% CI 1.3-7.1), altered mental status (OR 2.9, 95% CI 1.2-7.0), and a history of only provoked seizures (OR 2.8, 95% CI 1.0-7.5). Patients with 2 risk factors had an OR 6.9 (95% CI 1.8 – 26.5) for an ACM, those with 3-4 risk factors had an OR of 45.8 (95% CI 9.8-213.2). The negative predictive value for ACM in a patient with no risk factors was 98.6% (95% CI 95.9 - 99.5).Discussion:Patients with a NIS who have abnormal neuroimaging associated with an ACM present with unique risk factors. Prospectively validating these factors may allow for a prediction tool for NIS in EDs where reduced exposure to ionizing radiation, sedation, and resource utilization is critically important.