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
