The evaluation and management of paediatric headaches

Dooley, Joe

doi:10.1093/pch/14.1.24

Cited by 25 publications

(35 citation statements)

References 49 publications

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“…It is important to remember that objective evidence is very frequently found in patients with secondary pathology causing headaches; for example, it is estimated in 98% of pediatric patient with a brain tumor abnormalities can be seen on physical examination. 15 There are some key features on history which should prompt further evaluation. These "red flags" include may indicate a diagnosis other than a primary headache disorder.…”

Section: Approach To the Patient With Headachementioning

confidence: 99%

Diagnosis and Management of Childhood Headache

Gofshteyn

Stephenson

2016

Current Problems in Pediatric and Adolescent Health Care

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Section: Approach To the Patient With Headachementioning

confidence: 99%

Diagnosis and Management of Childhood Headache

Gofshteyn

Stephenson

2016

Current Problems in Pediatric and Adolescent Health Care

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“…1,4 Thus, neuroimaging is considered unnecessary in the diagnosis of headache when no other neurologic symptoms are present to suggest serious intracranial pathology. 1,[5][6][7][8][9][10][11][12][13] Not only is neuroimaging clinically unnecessary for children with isolated headache, it is also associated with potential long-term health risks. CT scans involve larger doses of radiation than conventional radiographs 14 and have been proposed to increase a child' s lifetime risk of cancer.…”

mentioning

confidence: 99%

CT Scan Utilization Patterns in Pediatric Patients With Recurrent Headache

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Although unnecessary for children with headache and normal history, computed tomography (CT) scans are widely used. Fewer than 1% of pediatric brain abnormalities present with headache as the only symptom. Furthermore, repeated CT scans may increase lifetime risk of cancer.WHAT THIS STUDY ADDS: CT scans continue to be used to diagnose isolated pediatric headaches despite existing practice parameters. Although emergency department visits were correlated with greater likelihood of CT scan use, these scans were widely used across a variety of clinical settings. abstract OBJECTIVE: Although unnecessary for children with headache and normal history, computed tomography (CT) scans are widely used. This study sought to determine current practice patterns of neuroimaging to diagnose pediatric headache in a variety of treatment settings and to identify factors associated with increased use of neuroimaging. METHODS:This retrospective claims analysis included children (aged 3-17 years) with $2 medical claims for headache. The primary outcome was CT scan utilization on or after first presentation with headache in a physician' s office or emergency department (ED). RESULTS:Of 15 836 patients, 26% (4034 patients; mean age: 11.8 years) had $1 CT scan, 74% within 1 month of index diagnosis. Patients with ED visits were 4 times more likely to undergo a CT scan versus those without ED visits (P , .001 [95% confidence interval: 3.9-4.8]). However, even outside the ED, use of CT scans remained widespread. Two-thirds of patients with CT scans had no ED use. Among patients with no ED utilization, .20% received a CT scan during the study period. Evaluation by a neurologist was strongly associated with a lower likelihood of CT scan compared with other provider specialties (odds ratio: 0.37; P , .01 [95% confidence interval: 0.30-0.46]).CONCLUSIONS: Use of CT scans to diagnose pediatric headache remains high despite existing guidelines, low diagnostic yield, and high potential risk. Implementing quality improvement initiatives to ensure that CT scans in children are performed only when truly indicated will reduce unnecessary exposure to ionizing radiation and associated cancer risks. Pediatrics 2013;132:e1-e8 AUTHORS:

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“…With careful and intentional clarifying follow‐up questions, symptoms and patterns typically begin to emerge. The standard of evaluation for headaches includes gathering a headache history, completing a general physical examination, and performing a thorough neurologic examination (Dooley, 2009). First, it is most important to gather a detailed history of headache pain from the patient and the family, with emphasis on the child's account of headache pain.…”

Section: Evaluation and Diagnosismentioning

confidence: 99%