Brain Imaging Findings in Children with Headache

Neuroimaging Findings in Pediatric Chronic Headaches: Is Imaging Always Necessary?

Background

Considering the high cost of Magnetic Resonance Imaging and the high risk of radiation exposure to growing children from Computed tomography scans, we aim to evaluate the neuroimaging findings in children with chronic headaches, determine the frequency of significant remediable pathologies, and establish the need for neuroimaging.

Methodology

This is a cross-sectional study of clinical data and neuroimaging findings in 41 children who were imaged in a tertiary hospital and a private diagnostic center in Abuja on account of chronic headaches. Twenty-two children were referred for brain Computed Tomography scan while 19 had brain Magnetic resonance Imaging. Collected data was statistically analyzed using SAS software version 9.3 with the level of significance set at 0.05.

Results

The age range of patients was 4 -18years.Thirty-three patients (80.5%) had chronic primary headaches while eight (19.5%) patients had additional "red flag" indications. Normal findings and extracranial lesions accounted for 89.5% of MRI (17/19) and 72.7% (16/22) in CT. Intracranial lesions were seen in 75% of patients with "red flag" and 6.1% of patients with primary headache with significant differences (p=0.0001) between the subsets. The commonest abnormalities were chronic sinusitis (17.1%) and intracranial tumors (9.6%) with no significant difference in the overall neuroimaging findings across the age groups. Chronic sinusitis was found predominantly in adolescent females (85.7%).

Conclusions

Neuroimaging has a low yield of significant remediable intracranial lesions in children with chronic headaches without additional "red flag" symptoms thereby necessitating the call to reconsider the use of neuroimaging with a view to imaging gently.

Dedicated neuroimaging analysis in children with primary headaches: prevalence of lesions and a comparison between patients with and without migraines

BACKGROUND

This study evaluated the prevalence and types of intracranial lesions through dedicated imaging analysis of primary headaches in children and compared them between patients with and without migraine.

METHODS

This study included 190 children diagnosed with primary headache who underwent neuroimaging, including brain computed tomography (CT), CT angiography (CTA), and brain magnetic resonance imaging (MRI). All patients with primary headaches was divided into two groups, namely, the migraine and non-migraine groups, on the basis of data from electronic medical records. Clinical characteristics and imaging findings were evaluated and compared between the two groups.

RESULTS

Patients with migraine were old and had a longer period from symptom onset to diagnosis. CT was normal in 71 of 95 patients, whereas 7 of 29 patients who underwent CTA had vascular lesions; the migraine group (n = 6/20, [30%]) had higher incidence of vascular lesions than the non-migraine group (n = 1/9, [11.1%]); however, there was no statistically significant difference (p = 0.382). Furthermore, 57.5% (61/106) of children showed normal brain MRI. The most common brain MRI finding was dilated perivascular space (n = 18, [16.8%]). Most perivascular spaces were located in the basal ganglia (n = 72, [75.8%]) and were in linear patterns (n = 58, [63.0%]). There was no statistically significant difference between the two groups.

CONCLUSION

A low prevalence of significant abnormalities was found in children with primary headaches. Dilated perivascular space was the most common finding in both groups on MRI. CTA showed more vascular lesions in the migraine group than in the non-migraine group. Therefore, further evaluations are needed to reveal the relationship between vascular lesions or dilated perivascular space and pediatric primary headaches.

Diagnostic Yield of Neuroimaging for Headache in a Pediatric Emergency Department: A Single Tertiary Centre Experience

OBJECTIVES

This study aimed to examine headache neuroimaging findings among the pediatric population visiting the emergency department in Saudi Arabia.

METHODS

This was a cross-sectional retrospective study of pediatric patients who presented to the emergency department with a headache as their primary complaint. Data were extracted from the electronic medical files of the patients at King Abdullah Specialized Children Hospital (KASCH) between 2015 and 2020. The diagnosis of headache was confirmed using a computerized tomography (CT) scan or magnetic resonance imaging (MRI) upon the patients' presentation.

RESULTS

A total of 263 patients met the inclusion criteria, and their data were extracted. The CT scans were abnormal in 50% of the patients. The MRI showed abnormal findings for 26% of the patients. CT scans and MRI identified that abnormalities were predominantly among patients with the secondary type of headache. The most common abnormal findings on CT were sinusitis (16%), masses (7%), and hydrocephalus (7%). The most common abnormal findings on MRI were masses (8%), cysts (5%), and hydrocephalus (3%). Of all patients with headaches, 10% had a prior diagnosis of headache, and 12% had a family history of headache. A significantly higher percentage of patients with secondary headache were prescribed NSAID and required admission compared to patients with primary headache (p ≤ 0.05). There was no statistically significant differences in the proportion of patients diagnosed with primary and secondary headache in terms of their neurological examination and headache types (p = 0.43).

CONCLUSIONS

Neuroimaging is essential for diagnosing headaches in children. Headaches were associated with sinusitis in children. The secondary type was more likely to have abnormal CT and MRI results. Primary type headaches were more common in those with a family history. CT scans and MRIs are needed when a headache is accompanied by an abnormal clinical evaluation. Neuroimaging and mild CT usage may be explored if there are clinical abnormalities or family history.

An update on practice guidelines for primary care treatment of pediatric migraine

ABSTRACT

Headaches are a frequent reason for children and adolescents to seek healthcare, and such visits include pediatric ED visits. Headache-related school absences can affect academic performance. Diagnosing and treating headaches in this population can be challenging for the primary care NP. This article reviews recent management and treatment guidelines.

Mechanisms of migraine as a chronic evolutive condition

Understanding the mechanisms of migraine remains challenging as migraine is not a static disorder, and even in its episodic form migraine remains an "evolutive" chronic condition. Considerable progress has been made in elucidating the pathophysiological mechanisms of migraine, associated genetic factors that may influence susceptibility to the disease, and functional and anatomical changes during the progression of a migraine attack or the transformation of episodic to chronic migraine. Migraine is a life span neurological disorder that follows an evolutive age-dependent change in its prevalence and even clinical presentations. As a disorder, migraine involves recurrent intense head pain and associated unpleasant symptoms. Migraine attacks evolve over different phases with specific neural mechanisms and symptoms being involved during each phase. In some patients, migraine can be transformed into a chronic form with daily or almost daily headaches. The mechanisms behind this evolutive process remain unknown, but genetic and epigenetic factors, inflammatory processes and central sensitization may play an important role.