The Role of Neuroimaging in Children and Adolescents With Recurrent Headaches – Multicenter Study

Objectives.— To evaluate the role of neuroimaging and to estimate the prevalence of significant and treatable intracranial lesions in children and adolescents with recurrent headaches. Background.— Neuroimaging studies are commonly performed in children and adolescent patients with headache because of increasing demands by parents and physicians, although objective data and studies to support this widespread practice are minimal. Methods.— We retrospectively reviewed the medical records of all 1562 (male 724, female 838) new patients presenting with recurrent headaches to 9 Pediatric Neurology Clinics of tertiary Hospitals. Data regarding age of onset, duration of symptoms before presentation, frequency, duration of each episode, intensity, location and quality of headache, associated neurologic symptoms and a comprehensive neurological examination were obtained for each patient. The International Classification of Headache Disorders, second edition, was used to classify headache types. Results.— Neuroimaging procedures were performed in 77.1% of the patients. Overall, 9.3% (112/1204) of the patients had abnormal findings from neuroimaging. The highest yield was in patients with an abnormal neurological examination wherein abnormal findings on neuroimaging were seen in 50.0% (9/18) of patients ( P  < .001). The yield was low when imaging was carried out in view of changes in the type of headache (12.9% [26/201]), neurologic dysfunction (10.8% [9/83]), recent onset of severe headaches (7.0% [12/171]), and demands of parent and physicians (10.1% [21/208]). Eleven patients underwent surgery based on neuroimaging results. There was no significant relation between abnormality on neuroimaging and age, sex, headache type, age of onset of headache, duration of symptoms before presentation, duration, frequency, location and intensity of headache ( P  > .05). Conclusions.— Neuroimaging procedures in children and adolescents with headaches, although not always required, are very commonly performed. We suggest that more strict guidelines for rational use of neuroimaging are needed for pediatric headache patients.