Practice parameter: Evaluation of children and adolescents with recurrent headaches

Abstract

Abstract-Objective:The Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society develop practice parameters as strategies for patient management based on analysis of evidence. For this parameter, the authors reviewed available evidence on the evaluation of the child with recurrent headaches and made recommendations based on this evidence. Methods: Relevant literature was reviewed, abstracted, and classified. Recommendations were based on a four-tiered scheme of evidence classification. Results: There is inadequate documentation in the literature to support any recommendation as to the appropriateness of routine laboratory studies or performance of lumbar puncture. EEG is not recommended in the routine evaluation, as it is unlikely to define or determine an etiology or distinguish migraine from other types of headaches. In those children undergoing evaluation for recurrent headache found to have a paroxysmal EEG, the risk for future seizures is negligible; therefore, further investigation for epilepsy or treatments aimed at preventing future seizures is not indicated. Obtaining a neuroimaging study on a routine basis is not indicated in children with recurrent headaches and a normal neurologic examination. Neuroimaging should be considered in children with an abnormal neurologic examination or other physical findings that suggest CNS disease. Variables that predicted the presence of a space-occupying lesion included 1) headache of less than 1-month duration; 2) absence of family history of migraine; 3) abnormal neurologic findings on examination; 4) gait abnormalities; and 5) occurrence of seizures. Conclusions: Recurrent headaches occur commonly in children and are diagnosed on a clinical basis rather than by any testing. The routine use of any diagnostic studies is not indicated when the clinical history has no associated risk factors and the child's examination is normal.

Investigating the necessity of computed tomographic scans in children with headaches: a retrospective review

“…3 A single cranial computed tomographic (CT) scan delivers 20 to 56 mGy units of radiation to the brain, a radiation dose with significant risks. 4 A recent study demonstrated that a dose of 50 mGy can triple the risk of leukemia and doses of 60 mGy may triple the risk of brain cancer in pediatric patients.…”

“…Level B recommendations from class II and III evidence are that such patients should not undergo neuroimaging. 3 We suspect that many physicians may be unaware of these guidelines and needlessly exposing patients presenting with primary headaches to harmful radiation by ordering CT scans. Although the rationale for physician is complex and situation specific, it is possible that non-evidence-based factors are influencing decision making.…”

Arachnoid Cyst as a Rare Cause of Headache in a Teenager: Case Report

“…It was reported that prevalence of any type of headache range from 57-82% by age of 15 [1]. The most common causes of headache in children can be summarized as viral or upper respiratory infections including ear infections, common cold, allergies, sinus infections, and strep throat, stress-related or Manuscript accepted for publication December 12, 2012 a stress-worsened headaches including family or school problems, minor head injury, migraine or cluster headache, and tension.…”

“…Physical examination should include vital signs, particularly blood pressure, and neurological examination should include optic fundus [1]. The red flags in patients' medical history were summarized as age < 3 years, morning or nocturnal headache, morning or nocturnal vomiting, headache increased by Valsava or straining, explosive onset, progressively worsening over time (chronic progressive pattern), declining school performance or personality changes, altered mental status, and epilepsy [4].…”

“…This complaint constitutes a very high percentage of attendance to neurology as well as neurosurgery clinics. It is also common in children and it shows an increased prevalence during adolescence [1]. Most common causes of headache in children usually are not associated with serious causes such as space occupying lesion or life-threatening infection [2].…”