Pediatric headache: Are the red flags misleading or prognostic?

Köken, Özlem Yayıcı; Danis, A; Yüksel, Deniz; Aksoy, Ayşe; Öztoprak, Ülkühan; Aksoy, Erhan

doi:10.1016/j.braindev.2020.10.007

Cited by 8 publications

(15 citation statements)

References 19 publications

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“…Table 3 summarizes 17 red flag signs, with headache onset at <6 years of age also considered a red flag. Relative to prior research, our study indicated that headaches beginning before the age of 6 years, abnormal neurological signs or symptoms, systemic symptoms such as fever, and sudden onset were more indicative of secondary headache [1,3,15,16]. However, vomiting was a significant red flag only in patients under 12 years old in our study, while headaches triggered by coughing, exercise, and the Valsalva maneuver were significantly more common among patients over 6 years of age with primary headaches.…”

Section: Discussioncontrasting

confidence: 81%

“…This result contradicts those of previous studies [1,15]. Moreover, a high frequency of headache upon awakening was reported among patients over 6 years old with primary headaches, contradicting the findings of Yayici Koken et al [3], who reported that this feature (headache consistenly worse in the morning) was more common with secondary headaches. As headache duration increases, more patients are likely to report experiencing a headache immediately upon awakening.…”

Section: Discussioncontrasting

confidence: 78%

“…Therefore, it is crucial to identify patients who necessitate invasive examinations, such as blood tests, cerebrospinal fluid (CSF) analysis, and neuroimaging, to exclude secondary headache. This is achieved through a detailed history and physical examination of patients presenting with headaches, which can save time, effort, and financial resources [3]. In this context, red flags are clinical indicators that signal the need for neuroimaging to identify secondary causes of headaches [1].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Analysis and Red Flag Signs in Pediatric Headache According to Age

Jo,

Lee,

Shin

et al. 2024

Ann Child Neurol

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Purpose: The clinical characteristics of headaches vary by age among pediatric patients. Red flag signs are key factors in differentiating secondary headaches and should be considered in the context of the patient’s age.Methods: This study involved a retrospective chart review of pediatric patients presenting with headaches. Patients were categorized by age into three groups: pre-school age (under 6 years), school-age (6 to 12 years), and adolescence (over 12 years). Demographic data, headache characteristics, laboratory findings, and neuroimaging results were evaluated. Overall, 17 potential red flags were assessed.Results: A total of 687 patients were included, of whom 102 were of pre-school age, 314 were school-aged, and 271 were adolescents. The frequency of overweight/obesity was found to increase with age. The pre-school age group experienced a shorter period from symptom onset to presentation and a briefer duration of pain. In contrast, adolescents displayed a longer period from symptom onset, a greater frequency of headaches occurring at least three times per week, and a higher rate of headache episodes lasting over 3 days. Children under 6 years old were more commonly diagnosed with secondary headaches than older children. Across age groups, secondary headaches were suspected when systemic symptoms such as fever were present, when the headache had a sudden onset, when the patient responded poorly to medication, or when abnormal neurological signs and symptoms were observed.Conclusion: The clinical features of pediatric patients vary by age group. Clinicians should consider red flag signs in the context of patient age and individual characteristics.

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Section: Discussioncontrasting

confidence: 81%

Section: Discussioncontrasting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

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Clinical Analysis and Red Flag Signs in Pediatric Headache According to Age

Jo,

Lee,

Shin

et al. 2024

Ann Child Neurol

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“…Headache is a common symptom in children, even in preschoolers and represents one of the main neurological causes of access to the ED. Headache in children under six years of age is still considered a diagnostic challenge often requiring neuroimaging to exclude malignant causes (15,16,(23)(24)(25)(26)(27)(28). To date, there are few studies focused on this age group.…”

Section: Discussionmentioning

confidence: 99%

Children under 6 years with acute headache in Pediatric Emergency Departments. A 2-year retrospective exploratory multicenter Italian study

Raucci,

Parisi,

Ferro

et al. 2023

Cephalalgia

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Background Preschool age (i.e. children under six years of age) represents a red flag for requiring neuroimaging to exclude secondary potentially urgent intracranial conditions (PUIC) in patients with acute headache. We investigated the clinical characteristics of preschoolers with headache to identify the features associated with a greater risk of secondary “dangerous” headache. Methods We performed a multicenter exploratory retrospective study in Italy from January 2017 to December 2018. Preschoolers with new-onset non-traumatic headache admitted to emergency department were included and were subsequently divided into two groups: hospitalized and discharged. Among hospitalized patients, we investigated the characteristics linked to potentially urgent intracranial conditions. Results We included 1455 preschoolers with acute headache. Vomiting, ocular motility disorders, ataxia, presence of neurological symptoms and signs, torticollis and nocturnal awakening were significantly associated to hospitalization. Among the 95 hospitalized patients, 34 (2.3%) had potentially urgent intracranial conditions and more frequently they had neurological symptoms and signs, papilledema, ataxia, cranial nerves paralysis, nocturnal awakening and vomiting. Nevertheless, on multivariable logistic regression analysis, we found that only ataxia and vomiting were associated with potentially urgent intracranial conditions. Conclusion Our study identified clinical features that should be carefully evaluated in the emergency department in order to obtain a prompt diagnosis and treatment of potentially urgent intracranial conditions. The prevalence of potentially urgent intracranial conditions was low in the emergency department, which may suggest that age under six should not be considered an important risk factor for malignant causes as previously thought.

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“…Die Befundaufnahme, Untersuchung und Behandlung sollte sich am Clinical-Reasoning orientieren 29 , 30 . Um ‚Red flags‘ oder sonstige Auffälligkeiten zu erfassen, wird eine fundierte Anamnese mit Kind und Eltern durchgeführt 5 , 31 , 32 , 33 . Ergeben sich weder Kontraindikationen noch unklare und abweichende Faktoren, wird die physikalische Untersuchung durchgeführt.…”

Section: Anamneseunclassified

Physiotherapie von Kopfschmerz bei Kindern und Jugendlichen

Piekartz-Doppelhofer¹

2022

Schmerz.Therapie

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Pediatric headache: Are the red flags misleading or prognostic?

Cited by 8 publications

References 19 publications

Clinical Analysis and Red Flag Signs in Pediatric Headache According to Age

Clinical Analysis and Red Flag Signs in Pediatric Headache According to Age

Children under 6 years with acute headache in Pediatric Emergency Departments. A 2-year retrospective exploratory multicenter Italian study

Physiotherapie von Kopfschmerz bei Kindern und Jugendlichen

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