Diagnostics and management of pediatric headaches at a University Hospital

Aims: The use of standardized manuals for classification and management of pediatric headaches is incomplete and the symptom course mostly remains obscure.

To evaluate these factors we had a study on pediatric patients' headaches, seen in the outpatient clinic of a University Hospital. We evaluated via questionnaire the course of the children's complaints, their treatment adherence, and the families' satisfaction with the doctors' management.

Methods: Patients and methods: (1) n = 78 patients, all presenting with recurrent headaches in 2007 gave their informed consent. Retrospective analysis of the charts in respect to diagnosis, EEG recording, MRI, and treatment recommendations. (2) Evaluation of the symptoms course, adherence to treatment and satisfaction with the doctors' work-up 1 year thereafter.

Results: (1) Diagnoses were based on the International Classification of Headache Disorders, only 50% were completely done/recorded.

Diagnoses: Primary headaches n = 60 (73%), Migraine n = 36 (46%), tension headaches n = 21 (27%), unclassified headaches n = 14 (18%), and secondary headaches 7 (9%). Neuroradiological findings in 5 patients (6.5%).

Further diagnostics: EEG recording n = 64, Kindern (83%), cMRI n = 28 (36%). (2) Questionnaires, response rate n = 61 (78%): complete recovery n = 3 (6%), and improvement n = 28 (47%). Compliance with medical treatment: 0 to 47%. Compliance with nonmedical treatment: 14 to 18%. Satisfied with doctors management n = 48 (79%).

Conclusion: Standardized management could reduce the rate of unclassified headaches. This would improve EEG und MRI planning. The high rate of neuroradiological pathologies shows the special role of a level 1 hospital. The benign course of symptoms in combination with poor treatment adherence is a point of discussion.