Neuroimaging in Pediatric Headache

Camargo, Aline; Kanekar, Sangam

doi:10.1016/j.ncl.2022.02.007

Cited by 3 publications

(7 citation statements)

References 55 publications

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“…The first step in the evaluation of a child or adolescent with a headache is to distinguish between primary and secondary headaches [21]. Although most childhood headaches are benign, parents are frequently concerned about the possibility of a brain tumour or vascular malformation, especially if there is a family history of congenital aneurysms [17].…”

Section: Discussionmentioning

confidence: 99%

“…Symptoms alone cannot distinguish between primary and secondary headaches since patients with secondary headaches may experience the same symptoms as those with primary headaches [11][12][13]. Nonetheless, the main goal of the clinical history and examination is to look for "red flags" [21], which are clinical findings that point to a possible and serious cause of headaches, compelling physicians to perform advanced investigations [15]. Certain red flags are more common in patients with secondary headaches [43], and patients with one or more red flags are at a higher risk of underlying intracranial diseases [39].…”

Section: Discussionmentioning

confidence: 99%

“…Since headaches caused by ophthalmological problems are more frequently chronic, they are less common in emergency settings [24]. Although otorhinolaryngological consultation may be necessary if recurrent and chronic sinusitis is suspected [44], a diagnosis of acute uncomplicated sinusitis should be based solely on the clinical history and physical examination without the need for imaging [21].…”

Section: Discussionmentioning

confidence: 99%

“…The wide range of imaging rates reflects a lack of agreement or formal recommendations on the management of children and adolescents with headaches in the ED [26]. The decision to order imaging studies for children with headaches should involve risk stratification based on clinical history and physical examination to assess the benefits and risks of neuroimaging [21].…”

Section: Discussionmentioning

confidence: 99%

“…When deciding whether to perform an imaging study in children with headaches, risk stratification based on clinical history and physical examination should be considered to ensure that the benefits of neuroimaging exceed the risks of radiation exposure from CT scans or sedation for MRI [21]. However, defining reliable red flags for the prediction of severe disorders and, consequently, validating criteria for the appropriate use of neuroimaging during diagnostic workup are challenging [22].…”

Section: Introductionmentioning

confidence: 99%

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How Can Specialist Advice Influence the Neuroimaging Practice for Childhood Headache in Emergency Department?

Cappellari,

Bruschi,

Beretta

et al. 2023

Children

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Differentiating between primary and secondary headaches can be challenging, especially in the emergency department (ED). Since symptoms alone are inadequate criteria for distinguishing between primary and secondary headaches, many children with headaches undergo neuroimaging investigations, such as brain CT and MRI. In various studies, the frequency of neuroimaging utilization is influenced by several factors, including teaching status, ownership, metropolitan area, insurance status, and ethnicity of patients. However, only a few studies have considered the role of specialist consultations in ordering neuroimaging studies on childhood headaches. We report the contributions of different specialists to the evaluation of children with headaches admitted to the ED and their influence on neuroimaging decisions. We retrospectively reviewed the medical reports of paediatric patients who presented with headaches to the paediatric ED of the Ospedale Maggiore Policlinico of Milano between January 2017 and January 2022. Overall, 890 children with headaches were evaluated (mean age: 10.0 years; range: 1 to 17 years). All patients were examined by the ED paediatricians, while specialist consultations were required for 261 patients, including 240 neurological (92.0%), 46 ophthalmological (17.6%), and 20 otorhinolaryngological (7.7%) consultations. Overall, 173 neuroimaging examinations were required, of which 51.4 and 48.6% were ordered by paediatricians and neurologists, respectively. In particular, paediatricians required 61.4% of brain CT scans, and neurologists required 92.0% of brain MRI scans. In conclusion, paediatricians were responsible for the management of most children with headaches admitted to the ED, while specialist consultations were required only in about a third of the cases. Although there was no significant difference in the number of neuroimaging studies ordered by specialists, brain CT scans were most often used by paediatricians, and MRI scans by neurologists.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

How Can Specialist Advice Influence the Neuroimaging Practice for Childhood Headache in Emergency Department?

Cappellari,

Bruschi,

Beretta

et al. 2023

Children

View full text Add to dashboard Cite

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Brain imaging in children referred to pediatric neurology out-patients with headache

Sarı,

Bektaş,

Palabıyik

et al. 2024

Jornal de Pediatria

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MRT bei kindlichen Kopfschmerzen

Marie Anders,

Roth

2024

Kinder- und Jugendmedizin

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ZUSAMMENFASSUNGBei einem primären Kopfschmerz ist eine Bildgebung in der Regel nicht indiziert. Darunter fallen u. a. Migräne und Spannungskopfschmerzen, mit typischer Symptomatik. In solchen Fällen ist in der MRT-Bildgebung mit hoher Wahrscheinlichkeit kein pathologischer Befund zu erwarten.Kopfschmerzen, die nicht in diese Kategorie fallen, können sogenannte sekundäre Kopfschmerzen mit einer dem Kopfschmerz zugrundeliegenden Pathologie sein, die dann häufig auch im MRT sichtbar ist. Hierzu zählen z. B. atypische Kopfschmerzen, die sehr plötzlich aufgetreten sind oder in deren Verlauf sich relevante Veränderungen beobachten ließen. Andere, sogenannte “red flags”, die zu einer MRT-Abklärung führen sollten, sind neurologische Symptome, die den Kopfschmerz begleiten, wie auch afebrile Krampfanfälle oder Papillenveränderungen (Stauungspapille).Ein dabei auftretendes relevantes Problem sind inzidentelle Befunde in der MRT-Bildgebung, wie unspezifische Gliosen oder venöse Anomalien (DVA). Diese haben meistens keinen Zusammenhang mit Kopfschmerzen, führen aber – wenn einmal beschrieben – zu Beunruhigung. Eine ausführliche und gute Kommunikation über solche, meist harmlosen Befunde ist notwendig, schon vor der Untersuchung im Aufklärungsgespräch. Folgeuntersuchungen sind dann – wenn klinisch vertretbar – zu vermeiden.Manche anhaltenden Kopfschmerzen verunsichern aber Kinder und Eltern so stark, dass nur aus diesem Grunde eine MRT-Bildgebung erwogen wird. Beunruhigung allein – ohne die genannten red flags – ist aber keine ausreichende medizinische Indikation. Die Durchführung solcher MRT-Untersuchungen ist daher umstritten. Eine generelle Ablehnung solcher Untersuchungen ist in der Praxis aber kaum zu realisieren, Kinderarzt und Kinderradiologe werden hier weiter mit einer Indikationsgrauzone leben müssen.

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Neuroimaging in Pediatric Headache

Cited by 3 publications

References 55 publications

How Can Specialist Advice Influence the Neuroimaging Practice for Childhood Headache in Emergency Department?

How Can Specialist Advice Influence the Neuroimaging Practice for Childhood Headache in Emergency Department?

Brain imaging in children referred to pediatric neurology out-patients with headache

MRT bei kindlichen Kopfschmerzen

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