Headache with Focal Neurologic Signs in Children at the Emergency Department

Differentiating arterial ischaemic stroke from migraine in the paediatric emergency department

“…Migraine with aura is less common in children under 8 years of age, with a prevalence of 3% to 4% in children aged 3 to 7 years, versus 23% to 31% of teenagers. 3,7 By comparison, previous research suggests that approximately half of childhood AIS occurs in children aged less than 5 years at symptom onset. 4 Sudden symptom onset was significantly more common in children with AIS.…”

“…6 In a French study of 79 433 children, non-febrile, non-traumatic headache accounted for 2.6% of all emergency department presentations, and headache associated with at least one neurological deficit for 102 (0.13%) presentations. 7 In the subset of children with headache with focal symptoms, migraine with aura was the most common diagnosis, in 62% of all cases, followed by epilepsy-associated headache, in 26% of cases. 7 In contrast, cerebrovascular disorders accounted for 6% of cases, which is similar to a larger cohort of children with brain attacks from our institution (which included all children with migraine and some stroke patients in the current study).…”

“…7 In the subset of children with headache with focal symptoms, migraine with aura was the most common diagnosis, in 62% of all cases, followed by epilepsy-associated headache, in 26% of cases. 7 In contrast, cerebrovascular disorders accounted for 6% of cases, which is similar to a larger cohort of children with brain attacks from our institution (which included all children with migraine and some stroke patients in the current study). 8 Migraine is also the most common cause of brain attack (stroke-like) symptoms in children presenting to the emergency department, accounting for 11% to 29% of cases.…”

“…Headaches were the third leading neurological cause of referral to paediatric emergency departments, accounting for more than 340 000 visits per year, in a USA national survey . In a French study of 79 433 children, non‐febrile, non‐traumatic headache accounted for 2.6% of all emergency department presentations, and headache associated with at least one neurological deficit for 102 (0.13%) presentations . In the subset of children with headache with focal symptoms, migraine with aura was the most common diagnosis, in 62% of all cases, followed by epilepsy‐associated headache, in 26% of cases .…”

PPIENSENLo: A Novel Mnemonics in Spanish for Alarm Criteria in Secondary Headaches in Children

“…After a search in multiple electronic databases, we were unable to find any for secondary headaches in children in either language. With that in mind, we designed the following in Spanish: PPIENSENLo: (“Think about it,” in English), which stands for: P – Patrón clínico diferente/(Change in the clinical pattern) P – Postural, aparece o empeora con cambios de postura del cuerpo/(Postural: appearing/worsening with changes in body posture) I – Inmediato (dolor máximo desde el inicio)/(Immediate, maximum pain from the beginning) E – Evolución menor de 6 mese/(Evolution time less than 6 months) N – Nocturna, lo despierta del sueño o presente al despertar/(Nocturnal; it wakes the patient or is present upon awakening) S – Sistémicos, signos/síntomas (fiebre, escalo‐fríos, pérdida de peso)/(Systemic signs: fever, weight loss, tachycardia, chills) E – Edad menor a 3 años/(Age under 3 years) N – Neurosignos/neurosíntomas (incluyendo papiledema)/(Neurosymptoms/neurosigns, including papilledema) Lo – Localizada y recurrente/(Localized and recurrent) …”