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SHOULD BRAIN IMAGING BE USED IN CHILDREN WITH HEADACHES?

Headaches may be a symptom of potentially fatal brain lesions such as tumors, vascular anomalies, and hydrocephalus. This study examined the usefulness of brain imaging studies in detecting treatable conditions in children with chronic headaches. The authors evaluated 133 children with recurrent headaches of at least 1 week's duration in a tertiary care pediatric neurology clinic. Most patients were diagnosed with migraine (52 percent) or chronic tension headache (21 percent), and others were diagnosed with mixed tension- migraine, psychogenic, and post-traumatic headache. In 25 children (19 percent), the cause of headache was unclassified. A total of 78 children had brain-imaging studies: 27 had CT scans, 45 had MRIs, and 6 had both. Indications for brain imaging included atypical headache pattern, neurologic abnormalities, systemic symptoms, and parents' or doctors' concerns about brain tumors. Brain abnormalities were discovered in only four patients, but all of these were deemed incidental to the headaches, and none were potentially treatable lesions. Comment: Although chronic headaches may portend serious structural lesions, brain imaging studies should usually be reserved for children with clinical evidence of an underlying lesion (e.g., focal neurologic signs, vomiting, or change in headache pattern), and in very young children who are unable to verbalize their complaints.

— RA Dershewitz

Published in Journal Watch General Medicine September 22, 1995

Citation(s):

Maytal J, et al. The value of brain imaging in children with headaches. Pediatrics 1995 Sep 96 413-416.

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