Headache in the pediatric emergency department: A 5-year retrospective study

Rossi, Roberta; Versace, Antonio Giovanni; Lauria, Barbara; Grasso, Giulia; Castagno, Emanuele; Ricceri, Fulvio; Pagliero, R; Urbino, Antonio

doi:10.1177/0333102417748907

Cited by 28 publications

(36 citation statements)

References 22 publications

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“…Diffuse headache, vomiting, visual disturbances, pupillary abnormalities, nocturnal awakening with headache, strabismus, nystagmus, ataxia, paresthesia, cranial nerve palsy, weakness, altered mental status, speech difficulty, and meningismus findings were more prevalent in cases of severe headache. The proportion of patients admitted to the PED with symptoms of headache (0.6%) in our series was similar to prior studies, representing a range of 0.6-1.3% of PED visits [1,2,5,6,12,13].…”

Section: Discussionsupporting

confidence: 89%

“…In some studies, headache was found to be more common in the male sex (50.3-62.3%) [1,2,5,6,8]. Glatstein et al [12] evaluated 295 cases of headache retrospectively and reported that the rate of male sex was 44%.…”

Section: Discussionmentioning

confidence: 99%

“…Headache is one of the most frequent causes of admission to pediatric emergency departments (PED) [1,2]. The prevalence of headaches among children varies between 5.9% and 37.7%, and the incidence increases with age [2].…”

Section: Introductionmentioning

confidence: 99%

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Identification of High-Risk Patients in the Pediatric Emergency Department with Symptoms of Headache

2020

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Objective: It is vital to detect life-threatening conditions in patients presenting to the pediatric emergency department with symptoms of headache. In this study, we aimed to evaluate patients who presented to our pediatric emergency department with symptoms of headache, and to determine which findings deserved the most attention in the anamnesis and during physical examinations. Methods: Patients who presented to the pediatric emergency department with symptoms of headache between July 2018 and June 2019 in Ankara, Turkey, were evaluated, retrospectively. Results: During the study period, 743 patients were included in the study. The median (IQR) age was 160.0 (range, 20.0-192.0) months. The male and female distribution was 46.2% (n = 343) and 53.8% (n = 400), respectively. The most common cause of headache was upper respiratory tract infections (84.2%). Severe headache symptoms were present in 2.3% of the entire patient group. In 81.2% of the patients with severe headache, various pathologic neurologic findings such as diffuse headache, nocturnal awakenings, vomiting, visual disturbances, nystagmus, cranial nerve pathologies, weakness, altered mental status, speech difficulty, and meningismus were present. Seventy-nine (10.6%) patients underwent neurologic imaging, and 15 (19.0%) had pathologic findings. Conclusion: Our data support that the most common cause of headaches in the pediatric emergency department is upper respiratory tract infections. The coexistence of nocturnal awakenings and/or the presence of pathologic-neurologic findings are red flags for cases of severe headache.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

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Identification of High-Risk Patients in the Pediatric Emergency Department with Symptoms of Headache

2020

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“…Finally, the use of neuroimaging in our study was at the higher end of the 6.3% to 41% range noted in prior studies of children evaluated in both general and pediatric EDs with headaches (1)(2)(3)(5)(6)(7)39,45,46). One possible reason for the broad range of estimates is the different inclusion and exclusion criteria among the studies.…”

Section: Discussionmentioning

confidence: 84%

Red flag findings in children with headaches: Prevalence and association with emergency department neuroimaging

et al. 2018

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Background Clinicians appear to obtain emergent neuroimaging for children with headaches based on the presence of red flag findings. However, little data exists regarding the prevalence of these findings in emergency department populations, and whether the identification of red flag findings is associated with potentially unnecessary emergency department neuroimaging. Objectives We aimed to determine the prevalence of red flag findings and their association with neuroimaging in otherwise healthy children presenting with headaches to the emergency department. Our secondary aim was to determine the prevalence of emergent intracranial abnormalities in this population. Methods A prospective cohort study of otherwise healthy children 2-17 years of age presenting to an urban pediatric emergency department with non-traumatic headaches was undertaken. Emergency department physicians completed a standardized form to document headache descriptors and characteristics, associated symptoms, and physical and neurological exam findings. Children who did not receive emergency department neuroimaging received 4-month telephone follow-up. Outcomes included emergency department neuroimaging and the presence of emergent intracranial abnormalities. Results We enrolled 224 patients; 197 (87.9%) had at least one red flag finding on history. Several red flag findings were reported by more than a third of children, including: Headache waking from sleep (34.8%); headache present with or soon after waking (39.7%); or headaches increasing in frequency, duration and severity (40%, 33.1%, and 46.3%). Thirty-three percent of children received emergency department neuroimaging. The prevalence of emergent intracranial abnormalities was 1% (95% CI 0.1, 3.6). Abnormal neurological exam, extreme pain intensity of presenting headache, vomiting, and positional symptoms were independently associated with emergency department neuroimaging. Conclusions Red flag findings are common in children presenting with headaches to the emergency department. The presence of red flag findings is associated with emergency department neuroimaging, although the risk of emergent intracranial abnormalities is low. Many children with headaches may be receiving unnecessary neuroimaging due to the high prevalence of non-specific red flag findings.

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“…[2][3][4][5] Although the majority of pediatric ED visits for headache are due to secondary causes, migraine accounts for between 5.4% and 28.7% of these visits. [2][3][4][5][6][7] Despite how common it is, the evidence for how to manage migraine in the pediatric ED is very limited, with only three randomized controlled trials having been carried out in this area. [8][9][10] The recurrence of headache and migraine relapse following treatment in the ED is also very common; 26% to 68% of pediatric patients have recurrence of their migraine within one week of ED discharge.…”

Section: Introductionmentioning

confidence: 99%

Oral dexamethasone for the prevention of acute migraine recurrence in pediatric patients presenting to the emergency department with migraine

Orr

Richer

Barrowman

et al. 2018

Cephalalgia Reports

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Objective: To assess the feasibility of a randomized controlled trial protocol that aims to determine the efficacy and safety of oral dexamethasone compared to placebo for the prevention of migraine recurrence in children and adolescents visiting the pediatric emergency department (ED) with migraine. Methods: This study was a two-arm, parallel-group, randomized, placebo-controlled, double-blind pilot trial of patients presenting to the pediatric ED with migraine. Eligible participants were randomized at 1:1 ratio to receive either oral dexamethasone 0.6 mg/kg (maximum 15 mg) or matched placebo as a single dose. Efficacy and safety outcomes were assessed at discharge, 48 h and 7 days after discharge. The primary outcome of the trial was feasibility and was assessed through participant recruitment rate, follow-up completion rates, participant satisfaction ratings and comparison of enrolled versus non-enrolled participants. Efficacy and safety outcomes were not analyzed given that this was a pilot study. Results: Twelve participants were enrolled over the 6-month recruitment period. This represents 60% of the planned sample size and a 10.5% recruitment rate. No other feasibility issues were identified and patients expressed high satisfaction rates with their treatment: 90.9% were satisfied with their treatment at discharge and at 48-h follow-up and 81.8% were satisfied with their treatment at 7-day follow-up (81.8%). There were no significant differences observed when comparing enrolled participants to those not enrolled. Conclusion: This pilot randomized controlled trial is the first to assess dexamethasone in the pediatric ED for the prevention of migraine recurrence. The protocol is feasible but recruitment in a single center was lower than expected. Future pediatric ED migraine studies may use innovative or pragmatic trial designs to maximize feasibility from a recruitment standpoint.

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Headache in the pediatric emergency department: A 5-year retrospective study

Cited by 28 publications

References 22 publications

Identification of High-Risk Patients in the Pediatric Emergency Department with Symptoms of Headache

Identification of High-Risk Patients in the Pediatric Emergency Department with Symptoms of Headache

Red flag findings in children with headaches: Prevalence and association with emergency department neuroimaging

Oral dexamethasone for the prevention of acute migraine recurrence in pediatric patients presenting to the emergency department with migraine

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