Headache in an Italian pediatric emergency department

Abstract

The objective of this study was to assess epidemiology, diagnostic work-up, treatment and follow-up of children presenting to emergency department (ED) with headache. Records of visits for non-traumatic headache to the ED of a pediatric hospital over a period of 12 months were retrospectively reviewed. Headache center charts were analyzed one year after. Five-hundred and fifty patients (1% of all ED visits) were included. Spectrum of diagnoses was: primary headache (56.7%), with 9.6% of migraine; secondary headache (42%); unclassified headache (1.3%). Viral illnesses accounted for 90.5% of secondary headaches. A serious disorder was found in 4% of patients. Forty-four patients (8%) underwent neuroimaging studies, with 25% of abnormal findings. Only 223 patients (40.5%) received pharmacological treatment. On discharge, 212 patients (38.5%) were referred to headache center and 114 (20.7% of all patients) attended it. ED diagnosis was confirmed in 74.6% of cases. Most of ED repeated visits (82.6%) occurred in patients not referred to headache center at discharge from first ED visit. The most frequent diagnosis was primary headache; viral illnesses represented the majority of secondary headaches. Underlying serious disorders were associated with neurological signs, limiting the need of diagnostic investigations. Well structured prospective studies are needed to evaluate appropriate diagnostic tools, as well as correct therapeutic approach of pediatric headache in emergency. Collaboration with headache center might limit repeated visits and provide a correct diagnostic definition.

Acute migraine in the Emergency Department: extending European principles of management

“…Similar results have been found in paediatric ED attendances, 1% of which were attributed by an Italian survey to headache [15]. Primary headache was again diagnosed in most cases (57%).…”

“…Primary headache was again diagnosed in most cases (57%). However, over 90% of secondary headaches were caused by viral illnesses, and only 4% of children were in any immediate danger [15].…”

Occipital Headaches and Neuroimaging in Children

“…5 The American Academy of Neurology/Child Neurology Society practice parameter supports the use of neuroimaging in patients with recurrent headaches and abnormal neurologic examination findings, seizures, or a history of recent-onset severe headache or recent changes in the nature of the headache. 4 Multiple pediatric emergency department (ED) studies have tried to identify warning signs deserving further workup, [6][7][8][9][10] and 2 of the studies suggested that an occipital headache location signified intracranial pathology. 7,9 Other warning signs not addressed in the practice parameter included younger age, severe intensity, and an inability to describe the quality of the pain.…”

Headache as an Emergency in Children and Adolescents

“…ED diagnosis was confirmed in 74.6 % of cases. Most ED repeated visits (82.6 %) occurred in patients not referred to the headache center at discharge from the first ED visit [9].…”