Neuroimaging Findings in Pediatric Chronic Headaches: Is Imaging Always Necessary?
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Keywords
CT, MRI, Pediatric, Chronic Headaches
Abstract
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.
References
2. Abu-Arafeh I, Razak S, Sivaraman B, Graham C. Prevalence of headache and migraine in children and adolescents: a systematic review of population-based studies. Dev Med Child Neurol.2010; 52:1088–97.
3.Ofovwe GE, Ofili AN. Prevalence and impact of headache and migraine among secondary school students in Nigeria. Headache: The Journal of Head and Face Pain. 2010;50(10):1570-5.
4. Hayes LL, Palasis S, Bartel TB, Booth TN, Iyer RS, Jones JY, Kadom N, Milla SS, Myseros JS, Pakalnis A, Partap S. ACR appropriateness criteria® Headache–child. Journal of the American College of Radiology. 2018;15(5): S78-90.
5. Roser T, Bonfert M, Ebinger F, Blankenburg M, Ertl-Wagner B, Heinen F. Primary versus secondary headache in children: a frequent diagnostic challenge in clinical routine. Neuropediatrics. 2013;44(1):34-9
6. Simpson GC, Forbes K, Teasdale E, Tyagi A, Santosh C. Impact of GP direct-access computerized tomography for the investigation of chronic daily headache. British Journal of General Practice. 2010;60(581):897-901.
7. Schankin CJ, Ferrari U, Reinisch VM, Birnbaum T, Goldbrunner R, Straube A. Characteristics of brain tumour-associated headache. Cephalalgia. 2007 Aug;27(8):904-11.
8. Itanyi UD, Okechukwu AA Computed tomography imaging features of chronic Headaches in Abuja, Nigeria. AJMH. 2017;5(4): 1-8.
9. Health Quality Ontario. Neuroimaging for the evaluation of chronic headaches: An evidence-based analysis. Ontario Health Technology Assessment Series. 2010; 10(26):1.
10. National Cancer Institute. Radiation Risks and Pediatric. Computed Tomography (CT): A Guide for Healthcare Providers. Bethesda, MD, USA: National Cancer Institute; 2002
11. Zubcevic S, Heljic S, Catibusic F, Uzicanin S, Sadikovic M, Krdzalic B. Neurodevelopmental follow up after therapeutic hypothermia for perinatal asphyxia. Medical Archives. 2015; 69(6):362.
12. Gurkas E, Karalok ZS, Taskın BD, Aydogmus U, Yılmaz C, Bayram G. Brain magnetic resonance imaging findings in children with headaches. Headache. 2017; 115(6): e349-55.
13. Schiller JS, Lucas JW, Ward BW, Peregoy JA Summary health statistics for U.S. adults: National Health Interview Survey. Vital Health Stat 2012:10(252):1-207
14. Behzadmehr Razieh, Arefi Sara, Behzadmehr Reyhane. Brain imaging findings in children with headache. AIM. 2018; 26(1):51.
15. Talebian A, Kohnavard M, Tabasi AS. Evaluation of brain CT scan in children with chronic and recurrent headaches in Kashan in the year 1996. JMUMS. 2000; 10(29): 30-5.
16. Nawaz M, Amin A, Qureshi AN, Jehanzeb M. Audit of appropriateness and outcome of computed tomography brain scanning for headaches in paediatric age group. J Ayub Med Coll Abbottabad. 2009 Mar 1;21(1):91-3.
17. Raucci U, Della Vecchia N, Ossella C, Paolino MC, Villa MP, Reale A et al. Management of Childhood Headache in the Emergency Department. Review of the literature. Frontiers in neurology. 2019; 10:886.
18. Lewis DW, Dorbad D. The utility of neuroimaging in the evaluation of children with migraine or chronic daily headache who have normal neurological examinations. Headache: The Journal of Head and Face Pain. 2000 Sep;40(8):629-32.
19. Fallah R, Abedi MA. The evaluation of children’s brain CT scan results and its relationship with requesting clinical complaints. Internal Medicine Today. 2008 Apr 10;14(1):27-32.
20. Mettler Jr FA, Bhargavan M, Faulkner K, Gilley DB, Gray JE, Ibbott GS, et al. Radiologic and nuclear medicine studies in the United States and worldwide: frequency, radiation dose, and comparison with other radiation sources—1950–2007. Radiology2009 Nov;253(2):520-31.
21. Hernanz-Schulman M. Pediatric CT and Image Gently. Image Wisely. 2010:2006-8.
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