The Quality Standards Subcommittee of the American Academy of Neurology, The Practice Committee of the Child Neurology Society. 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.

Abstract

Neurology. 2002;59:490‐498. OBJECTIVE: The Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society develop practice parameters as strategies for patient management based on analysis of evidence. For this parameter, the authors reviewed available evidence on the evaluation of the child with recurrent headaches and made recommendations based on this evidence. METHODS: Relevant literature was reviewed, abstracted, and classified. Recommendations were based on a four‐tiered scheme of evidence classification. RESULTS: There is inadequate documentation in the literature to support any recommendation as to the appropriateness of routine laboratory studies or performance of lumbar puncture. EEG is not recommended in the routine evaluation, as it is unlikely to define or determine an etiology or distinguish migraine from other types of headaches. In those children undergoing evaluation for recurrent headache found to have a paroxysmal EEG, the risk for future seizures is negligible; therefore, further investigation for epilepsy or treatments aimed at preventing future seizures is not indicated. Obtaining a neuroimaging study on a routine basis is not indicated in children with recurrent headaches and a normal neurologic examination. Neuroimaging should be considered in children with an abnormal neurologic examination or other physical findings that suggest CNS disease. Variables that predicted the presence of a space‐occupying lesion included 1) headache of less than 1‐month duration; 2) absence of family history of migraine; 3) abnormal neurologic findings on examination; 4) gait abnormalities; and 5) occurrence of seizures. CONCLUSIONS: Recurrent headaches occur commonly in children and are diagnosed on a clinical basis rather than by any testing. The routine use of any diagnostic studies is not indicated when the clinical history has no associated risk factors and the child's examination is normal. Comment: An important paper which summarizes the evidence for reaching a clinical diagnosis in children with recurrent headaches, while at the same time avoiding unnecessary and potentially harmful investigations. DSM

Complementary and Conventional Medicine Use Among Youth With Recurrent Headaches

“…In addition, the prevalence of HA is 2 times greater among the 18.4% of youth aged 12 to 17 who have special health care needs (16.0%). 12 Studies suggest that many youth with HA experience HA on a weekly basis [13][14][15][16][17][18][19] and that they are 4 times more likely to miss an above routine number of school days and to have repeated emergency department visits. 20 Common conventional recommendations to prevent HA include improving lifestyle, particularly diet, sleep, and stress.…”

Ectopia amigdalina cerebelosa borderline en un niño con cefalea. Caso clínico

“…7 El examen neurológico anormal o el antecedente de convulsiones, la sospecha de una infección intracraneal o de un trastorno concomitante que predispone al niño a una patología cerebral (por ejemplo: hipertensión y coagulopatía), o el cambio en el tipo o carácter de la cefalea son algunas de las indicaciones para la realización de un estudio de diagnóstico por imágenes. 8 Las neuroimágenes permiten un diagnóstico más preciso de los trastornos del sistema nervioso central; sin embargo, los hallazgos incidentales plantean un desafío para los médicos. Estos desafíos se ilustran mejor por el hallazgo de un tipo leve de malformación de Chiari I, ahora descrita comúnmente como EACB.…”

Resultados de la resonancia magnética nuclear de cerebro en niños con cefalea

“…4 Asimismo, también se hicieron estos estudios cuando los pacientes, o los padres, estaban muy preocupados con respecto a la posibilidad de una enfermedad cerebral preexistente grave y no estaban convencidos con la opinión del médico.…”

“…Según estas recomendaciones, entre las indicaciones para la realización de estudios de diagnóstico por imágenes d e l c r á n e o s e i n c l u y e n c e f a l e a aguda intensa, examen neurológico anormal, cambios en el patrón de la cefalea, signos de aumento de la presión intracraneal y coexistencia de convulsiones. 4 Sin embargo, en la práctica clínica, los estudios de neuroimagenología suelen solicitarse durante la evaluación inicial de los niños con cefalea debido al temor de pasar por alto una enfermedad Artículo original e350 / Arch Argent Pediatr 2017;115(6):e349-e355 / Artículo original grave y las exigencias cada vez mayores de los padres. Con el aumento de la tasa de realización de procedimientos de neuroimagenología, también se ha incrementado la detección casual de anomalías no relacionadas con la cefalea.…”