Value of MRI in Pediatric Migraine

McAbee, Gary N.; Siegel, Sheryl E.; Kadakia, Satish; Cantos, Eric L.

doi:10.1111/j.1526-4610.1993.hed3303143.x

Cited by 10 publications

(9 citation statements)

References 3 publications

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“…In comparison with previous reports, 7–9 the present study demonstrated that a substantially higher proportion of children with a history of headache – presenting to a university neuropediatric outpatient clinic – had abnormal findings on both physical and neurological examination.…”

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confidence: 77%

Role of MRI and EEG in the initial evaluation of children with headaches

Martens

Oster²,

Papanagiotou³

et al. 2012

Pediatrics International

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We read with great interest the study by Pavone et al., assessing the role of routine ophthalmologic examination, brain magnetic resonance imaging (MRI), electroencephalography (EEG), echocardiogram, and electrocardiogram in 300 children with primary headaches. 1 Although routine laboratory analysis and neurophysiologic investigations were unrevealing when neurologic examination was normal, the authors concluded that EEG and ophthalmologic studies and cerebral MRI (cMRI) are advisable because they have the potential to show abnormal pathologic findings, even in the absence of alarming clinical signs. 1 Of importance, negative results on cMRI may relieve parental anxiety, which in turn may positively impact on the clinical course of headache in children and adolescents. 1 We would like to add further data on this important issue by sharing our experience on the routine use of cMRI and EEG in children with first-episode headaches presenting to a tertiary university hospital.A total of 209 patients were included in the study (age 3-17 years; mean age, 11.3 years; male, n = 91, 43.5%; female, n = 118, 56.5%). The following types of headaches were seen: unclassified headache, n = 49 (23.4%); probable migraine, 17.2%; migraine without aura, 13.4%; complicated migraine, 12.4%; migraine with aura, 1.0%; tension-type, 15.3%; and cluster headaches, 0.5%; and secondary headaches, 16.7%.In 77.0% (161) of all children, abnormal findings on physical and neurological examination were noted. Physical and neurological findings (multiple entries possible) included the following in order of frequency: nausea (n = 57; 27.3%), vomiting (n = 55; 26.2%), vision disturbances (n = 55; 26.3%), vertigo (n = 45; 21.5%), photophobia (n = 27; 12.9%), phonophonia (n = 17; 8.1%), paraesthesias (n = 17; 8.1%), syncope (n = 18; 8.6%), speech impediment (n = 12; 5.7%), fever (n = 9; 4.3%) and papilloedema (n = 6; 2.9%), gait abnormalities (n = 5; 2.4%), and facial palsy (n = 4; 1.9%). Less common symptoms and clinical signs on neurological examination were: hearing disorder (n = 4; 1.9%), hemiplegic symptoms (n = 2, 1.0%), aphasia, hearing disorder, miosis, amnesia, paralysis, muscle spasms, and taste disorders (n = 1 each; 0.5%). In 23.0% (48) of all children, no physical or neurological signs/abnormalities were seen.The duration and history of headaches lasted: <1 day (n = 49), 1-7 days (n = 23), 1-4 weeks (n = 31), or longer (n = 56); no data for the duration of headaches could be elicited in 50 patients.On cMRI the following findings were seen: no pathological findings, n = 157 (75.1%); infection of sinuses, n = 15 (7.2%); pineal cysts, n = 5 (2.4%); arachnoidic cyst and Chiari malformation, n = 4 each (1.9%), unspecified signal enhancement, n = 2 (1.0%), pituitary adenoma, cerebral ischemia, inflammatory lesion, angioma, and intra-cerebral cyst (n = 1, each 0.5%).Electroencephalographic findings included: no pathological findings, n = 173 (82.8%); spike-wave complexes, n = 7 (3.3%); and both focal and generalized abnormal slowing (increased d...

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confidence: 77%

Role of MRI and EEG in the initial evaluation of children with headaches

Martens

Oster²,

Papanagiotou³

et al. 2012

Pediatrics International

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“…White matter lesions are the most common MRI abnormalities in adults suffering from migraine and a causal relation seems to be probable, since migraine-free controls showed significantly less frequent white matter lesions. 14 In contrast to the observations in adult migraineurs, McAbee et al 18 reported normal MRI findings in 24 children and adolescents with migraine. In our study, 4 of 98 patients with idiopathic headache (including 2 patients with coexisting organic disorders) showed white matter lesions.…”

Section: Commentsmentioning

confidence: 91%

“…7,13 Concerning MRI in recurrent headache in children and adolescents, there are only two studies, one including 7 patients out of a clinical series of 104 children referred for headache and another reporting normal intracranial findings in 24 migraineurs. 17,18 Considering the expectations of the parents that an organic cause of the child's headache will be definitely uncovered or excluded and considering case reports on intracranial diseases mimicking idiopathic headache, however, the question arises whether MRI is useful for routine evaluation of recurrent headache in childhood and adolescence. To clarify this question, we compared the value of MRI with that of clinical follow-up examinations in neurologically normal subjects with recurrent idiopathic headache.…”

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confidence: 99%

Magnetic Resonance Imaging for Recurrent Headache in Childhood and Adolescence

et al. 1996

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We investigated 429 consecutive patients, aged 5 to 18 (mean: 11.0 +/- 3.1) years, diagnosed with migraine or tension-type headache. The patients underwent either MRI or exclusively clinical follow-up examinations. Magnetic resonance imaging revealed normal findings in 82.3% and structural changes in 17.7%. However, the vast majority of these changes had minimal or no pathological relevance, and a causal relationship to the patient's headache could not be proven in any case. In the non-MRI group, clinical follow-up examinations confirmed the initial diagnosis in all patients and MRI was not required in any of these subjects. In conclusion, our study shows a poor relation between recurrent headache fulfilling the criteria of migraine and tension-type headache and structural changes incidentally detected by MRI. In addition, it suggests that clinical follow-up examinations are reliable. Accordingly, MRI is not required for routine examination of recurrent headache in children and adolescents, but it should be performed in patients with abnormal neurological findings, atypical headache pattern, or significant change of preexisting headache.

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“…Magnetic resonance imaging changes during migraine are rarely found. 10,11 Edema of white matter over the symptomatic hemisphere has been reported in a few cases. 12,13 It is unclear whether the meningeal enhancement seen was due to inflammation of the meninges since the CSF findings were not impressive for inflammation.…”

Section: Commentsmentioning

confidence: 99%

Familial Hemiplegic Migraine With Crossed Cerebellar Diaschisis and Unilateral Meningeal Enhancement

Crawford

Konkol

1997

Headache

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A 6-year-old boy with a family history of hemiplegic migraine had a hemiplegic migraine lasting for 6 days complicated by prolonged fever, lethargy, and two brief focal seizures. An acute single photon emission computerized tomogram (SPECT) demonstrated decreased blood flow in the symptomatic cerebral hemisphere as well as crossed cerebellar diaschisis not previously documented in migraine. Another unique finding was the MRI with enhancement of the meninges and pial vessels over the symptomatic cerebral hemisphere. These findings suggest cerebellar and extra-axial involvement as components of hemiplegic migraine.Key words: hemiplegic migraine, cerebellar diaschisis, meningeal enhancement Abbreviations:FHM familial hemiplegic migraine, SPECT single photon emission computerized tomography, CCD crossed cerebellar diaschisis (Headache 1997;37:590-593) Familial hemiplegic migraine (FHM) is an autosomal dominant syndrome mapped to a gene encoding a brain-specific calcium ion channel on chromosome 19. 1 Its clinical phenotype can be quite variable. Mildly affected family members suffer attacks which can consist of hemiparesis, hemiparesthesia, and hemianopic blurring followed by a severe pulsatile headache. Other family members may suffer from severe attacks with drowsiness, confusion, coma, and hyperpyrexia accompanying the hemiparesis which may last for several days. We report a child with FHM whose prolonged attack allowed extensive evaluation by CT, MRI, EEG, and single photon emission computerized tomography (SPECT). CASE HISTORYThis previously vigorous 6-year-old boy fell while at play without immediate sequelae. One hour later, he complained of left hand numbness and headache. Throughout the night, he had several episodes of emesis without rigors, chills, or stiff neck.Remote past history revealed that he had a pyIoric stenosis and type 1 truncus arteriosus repair in infancy. Eight months prior to his current illness, he had an hour-long episode of altered consciousness after bumping his head on the playground. Details of the episode were vague because the event occurred at school, and the child was nearly back to baseline by the time the mother arrived. Neurologic examination, EEG, and CT of the brain I month later were normal and no specific diagnosis was made.The family history revealed that his mother had frequent episodes of left-sided numbness and hand clumsiness followed by severe headaches from age 5 to age 23. Her father had a history of a prolonged coma after a concussion while playing football as a teenager. There was no seizure history.Physical examination revealed a well-nourished pale child with a temperature of 38.9°C who lay on the bed with eyes closed. His cardiac examination revealed a harsh 3/6 holosystolic murmur which radiated to the back. Abdominal and lung examinations were unremarkable. Mental status was significant for somnolence and irritability. He could state his name and name toys as well as follow simple commands. Cranial nerve examination revealed a left homonymous hemianopsia a...

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Value of MRI in Pediatric Migraine

Cited by 10 publications

References 3 publications

Role of MRI and EEG in the initial evaluation of children with headaches

Role of MRI and EEG in the initial evaluation of children with headaches

Magnetic Resonance Imaging for Recurrent Headache in Childhood and Adolescence

Familial Hemiplegic Migraine With Crossed Cerebellar Diaschisis and Unilateral Meningeal Enhancement

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