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Journal of Pediatric Neurology 2021; 19(02): 076-082
DOI: 10.1055/s-0040-1714106
Original Article

Diagnostic Yield of Neuroimaging and Electroencephalography in Children with Recurrent Headaches

Burcu Ozturk-Hismi 
1   Department of Pediatric Neurology, School of Medicine, Ankara University, Ankara, Turkey
2   Department of Pediatric Metabolic Diseases, School of Medicine, Marmara University, Istanbul, Turkey
,
Serap Teber
1   Department of Pediatric Neurology, School of Medicine, Ankara University, Ankara, Turkey
,
Mehpare Ozkan
1   Department of Pediatric Neurology, School of Medicine, Ankara University, Ankara, Turkey
,
Ozlem Unal
1   Department of Pediatric Neurology, School of Medicine, Ankara University, Ankara, Turkey
,
Gulhis Deda
1   Department of Pediatric Neurology, School of Medicine, Ankara University, Ankara, Turkey
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Abstract

Neuroimaging and electroencephalography (EEG) are commonly used for pediatric recurrent headache evaluation, although not routinely recommended. In this study, data of 517 children with recurrent headaches were analyzed to evaluate the diagnostic yield of neuroimaging and EEG. Neuroimaging was performed in 55% (n = 283) of children, 61% with magnetic resonance imaging and 39% with computed tomography. Abnormal findings were reported in 17% (n = 48), and 5% (n = 13) were significant abnormalities altering headache management. Among children with significant imaging abnormalities, 85% had alarming signs on history, physical, or neurological examination. The diagnostic yield of imaging was 0.7% (n = 2), picking a cavernous hemangioma and a giant arachnoid cyst. EEG was performed in 69% (n = 356) of children, significant findings were reported in 8% (n = 29), with sharp waves/spikes in 4.1% (n = 15), and intermittent focal slow waves in 3.9% (n = 14). EEG was diagnostic for epilepsy in 1.6% (n = 6) of children with recurrent headaches. When there are no red flags on history or physical examination, diagnostic yield of neuroimaging is low for pediatric recurrent headaches. EEG can be helpful in selective cases, and when performed during and at headache-free periods.

Keywords

headaches - children - imaging - electroencephalography

Authors' Contributions

B.O.H. contributed to the design, data collection, and was the primary author of the manuscript. G.D. and S.T. contributed to the design and edited the final manuscript; M.O., S.T., and O.U. helped data collection and edited the manuscript.




Publication History

Received: 17 May 2020

Accepted: 03 June 2020

Article published online:
10 August 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 GBD 2015 Neurological Disorders Collaborator Group. Global, regional, and national burden of neurological disorders during 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol 2017; 16 (11) 877-897
    CrossrefPubMedGoogle Scholar
  • 2 Bille BS. Migraine in school children. A study of the incidence and short-term prognosis, and a clinical, psychological and electroencephalographic comparison between children with migraine and matched controls. Acta Paediatr Suppl 1962; 136: 1-151
    PubMedGoogle Scholar
  • 3 Klein J, Koch T. Headache in children. Pediatr Rev 2020; 41 (04) 159-171
    CrossrefPubMedGoogle Scholar
  • 4 Lewis DW, Ashwal S, Dahl G. et al; Quality Standards Subcommittee of the American Academy of Neurology, Practice Committee of the Child Neurology Society. Practice parameter: evaluation of children and adolescents with recurrent headaches: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 2002; 59 (04) 490-498
    CrossrefPubMedGoogle Scholar
  • 5 Yonker M. Secondary headaches in children and adolescents: what not to miss. Curr Neurol Neurosci Rep 2018; 18 (09) 61
    CrossrefPubMedGoogle Scholar
  • 6 Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018; 38 (01) 1-211
    CrossrefPubMedGoogle Scholar
  • 7 Bayram E, Topcu Y, Karaoglu P, Yis U, Cakmakci Guleryuz H, Kurul SH. Incidental white matter lesions in children presentıng with headache. Headache 2013; 53 (06) 970-976
    CrossrefPubMedGoogle Scholar
  • 8 Bugdayci R, Ozge A, Sasmaz T. et al. Prevalence and factors affecting headache in Turkish schoolchildren. Pediatr Int 2005; 47 (03) 316-322
    CrossrefPubMedGoogle Scholar
  • 9 Deda G, Caksen H, Ocal A. Headache etiology in children: a retrospective study of 125 cases. Pediatr Int 2000; 42 (06) 668-673
    CrossrefPubMedGoogle Scholar
  • 10 Karli N, Akiş N, Zarifoğlu M. et al. Headache prevalence in adolescents aged 12 to 17: a student-based epidemiological study in Bursa. Headache 2006; 46 (04) 649-655
    CrossrefPubMedGoogle Scholar
  • 11 Alexiou GA, Argyropoulou MI. Neuroimaging in childhood headache: a systematic review. Pediatr Radiol 2013; 43 (07) 777-784
    CrossrefPubMedGoogle Scholar
  • 12 Pektezel MY, Konuskan B, Sonmez FM, Oguz KK, Anlar B. Pediatric headache and neuroimaging: experience of two tertiary centers. Childs Nerv Syst 2020; 36 (01) 173-177
    CrossrefPubMedGoogle Scholar
  • 13 Ozkan M, Teber ST, Deda G. Electroencephalogram variations in pediatric migraines and tension-type headaches. Pediatr Neurol 2012; 46 (03) 154-157
    CrossrefPubMedGoogle Scholar
  • 14 Parisi P, Belcastro V, Verrotti A, Striano P, Kasteleijn-Nolst Trenitè DGA. “Ictal epileptic headache” and the revised International Headache Classification (ICHD-3) published in Cephalalgia 2018, vol. 38(1) 1-211: not just a matter of definition!. Epilepsy Behav 2018; 87: 243-245
    CrossrefPubMedGoogle Scholar