Cerebral MRI and EEG studies in the initial management of pediatric headaches

Martens, Daniel; Oster, Isabel; Gottschlling, Sven; Papanagiotou, Panagiotis; Ziegler, Karin; Eymann, Regina; Ong, Mei Fang; Gortner, Ludwig; Meyer, Sascha

doi:10.4414/smw.2012.13625

Cited by 10 publications

(11 citation statements)

References 18 publications

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“…Twenty-one percent of imaged children (n ¼ 324) had abnormalities identified on MRI, largely incidental findings, with <1% having relevant findings to explain the headache, namely, tumor with hydrocephalus. Similarly, Martens et al [11] found that despite findings on neurologic and physical examinations in a substantial number of children with headaches, mostly migraines, the yield of brain MRI scans was low. Therefore, the yield of brain MRI is not contributory to the diagnostic and therapeutic approach.…”

Section: Discussion Of Procedures By Variant Variant 1: Child Primarmentioning

confidence: 99%

“…and the low yield of imaging in pediatric patients presenting with headaches alone bring into question the value of screening for patients with primary headaches. Pediatric headache literature has repeatedly reported that the value of neuroimaging in children with headache is generally low [9][10][11][12]. In a study by Yilmaz et al [12] of 449 children with headache, approximately 55% of children had migraine, 30% had tension-type headaches, 10% had secondary headaches, and 5% were unspecified.…”

Section: Introduction/backgroundmentioning

confidence: 99%

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ACR Appropriateness Criteria ® Headache–Child

Hayes

Palasis

Bartel

et al. 2018

Journal of the American College of Radiology

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Headaches in children are not uncommon and have various causes. Proper neuroimaging of these children is very specific to the headache type. Care must be taken to choose and perform the most appropriate initial imaging examination in order to maximize the ability to properly determine the cause with minimum risk to the child. This evidence-based report discusses the different headache types in children and provides appropriate guidelines for imaging these children. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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Section: Discussion Of Procedures By Variant Variant 1: Child Primarmentioning

confidence: 99%

Section: Introduction/backgroundmentioning

confidence: 99%

ACR Appropriateness Criteria ® Headache–Child

Hayes

Palasis

Bartel

et al. 2018

Journal of the American College of Radiology

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“…Our findings are in concordance with those reports indicating an incidence of true TTH in children at levels between 5 and 15% of all pediatric headaches. [31][32][33][34] Some reports, however, give values as high as 48% or even 56% and large discrepancies can even be found in publications by the same author. For example, in two articles published by Seshia in 2004, the incidence of TTH was indicated as 18% in one publication and as 56% in the other.…”

Section: Discussionmentioning

confidence: 97%

Reassessment of Pediatric Tension-Type Headaches

Vaiman

Mametov

Roitblat³

et al. 2020

Journal of Pediatric Neurology

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A retrospective multicenter chart review was conducted with the objective of evaluating the hypothesis that certain cases diagnosed as tension-type headache (TTH) in pediatric neurology are not stress-related or central sensitization-related conditions but may mimic an autoimmune disorder of the dura mater. Of the 29,642 patient charts reviewed, 12,424 charts (42%) were excluded because of incomplete data and 17,218 cases were analyzed. For all the 29,642 charts, TTH or chronic daily headaches were diagnosed in 29.2% of cases. Among the 17,218 cases subjected to detailed diagnostic procedures, TTH was diagnosed in only 5%. In 7,044 cases, the initial diagnosis of TTH was changed to headache attributed to infection (87.4%), which was supported by the presence of meningeal signs, high antistreptolysin-O titers, and, in 46% of cases, magnetic resonance imaging (MRI)-detected thickening of the cranial dura mater. The initial diagnosis of migraine was confirmed in 87.7% of cases (8,034/9,162). In some cases of treatment-resistant pediatric recurrent headaches, which are initially diagnosed as TTH, a secondary type of headache may be suspected as the underlying cause. Usually this type of headache has streptococcal infection-related laboratory findings, the meninges as the site of the lesion, and meningism as the clinical presentation.

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“…There are a few studies on the characteristics of EEGs according to the type of headache and the implication of EEGs for headache patients. EEG abnormalities were reported to vary (8.8–20%) in pediatric headache patients ( 8 , 10 , 11 ), and the most common abnormalities were epileptiform discharge seen in 0.4–20% of the patients ( 12 – 18 ). Piccinelli et al reported electroencephalographic abnormalities in 12.8% of all children with headaches ( 8 ).…”

Section: Discussionmentioning

confidence: 99%

EEG Characteristics and Diagnostic Implications in Childhood Headache: A Multi-Center Study

et al. 2020

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Introduction: Epilepsy and migraines are frequently observed as comorbidities, with the occurrence of one disorder increasing the probability of the other. The aim of our study was to evaluate the EEG characteristics by the type of headache and the implications of EEGs in headache patients, comparing the clinical characteristics and treatments between the headache patients with normal and abnormal EEGs. Methods: We conducted a retrospective analysis reviewing the medical records of 259 patients with headaches who visited the pediatrics departments of five university hospitals and underwent EEGs over a period of 3 years. Based on the data entered, analyses of the following items were conducted: (1) comparison of the EEG abnormalities by the type of headache and the characteristics of the EEG findings and (2) comparison of the clinical characteristics between patients with normal and abnormal EEGs. Results: Of the 259 patients, 31 showed abnormal EEGs, while 228 had normal EEGs. Of the 31 patients with abnormal EEGs, 17 showed epileptiform discharges, and 11 showed rhythmic slowing. The frequency of EEG abnormalities was significantly high in patients with migraines with auras than other types of headache. The Pediatric Migraine Disability Assessment (PedMIDAS) score was significantly higher in the abnormal EEG group compared with the normal EEG group ( p = 0.001). Conclusion: The results of this study suggest that the abnormal EEG group had more significant disruptions in their daily lives due to headaches than the normal EEG group and that patients with migraines with aura may need EEGs and they might also have overlapping pathophysiologic mechanisms with epilepsy.

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Cerebral MRI and EEG studies in the initial management of pediatric headaches

Cited by 10 publications

References 18 publications

ACR Appropriateness Criteria ® Headache–Child

ACR Appropriateness Criteria ® Headache–Child

Reassessment of Pediatric Tension-Type Headaches

EEG Characteristics and Diagnostic Implications in Childhood Headache: A Multi-Center Study

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