title: The role of neuroimaging in children and adolescents with recurrent headaches--multicenter study.
abstract: OBJECTIVE
  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.
authors.affiliation: From the Department of Pediatrics, School of Medicine, Chosun University, Gwangju, Korea (Y-I. Rho); Department of Pediatrics, National Health Insurance Corporation, Ilsan Hospital, Goyang, Korea (H-J. Chung); Department of Pediatrics, College of Medicine, Soonchunhyang University, Seoul, Korea (E-S. Suh); Department of Pediatrics, College of Medicine, Hallym University, Seoul, Korea (K-H. Lee); Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea (B-L. Eun); Department of Pediatrics, School of Medicine, Pusan National University, Yangsan, Korea (S-O. Nam); Department of Pediatrics, College of Medicine, Chungbuk National University, Chungju, Korea (W-S. Kim); Department of Pediatrics, College of Medicine, Korea University, Ansan, Korea (S-H. Eun); Department of Pediatrics, School of Medicine, Chonnam National University, Gwangju, Korea (Y-O. Kim).
authors.forename: Young-Il
authors.initials: YI
authors.lastname: Rho
authors.affiliation: From the Department of Pediatrics, School of Medicine, Chosun University, Gwangju, Korea (Y-I. Rho); Department of Pediatrics, National Health Insurance Corporation, Ilsan Hospital, Goyang, Korea (H-J. Chung); Department of Pediatrics, College of Medicine, Soonchunhyang University, Seoul, Korea (E-S. Suh); Department of Pediatrics, College of Medicine, Hallym University, Seoul, Korea (K-H. Lee); Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea (B-L. Eun); Department of Pediatrics, School of Medicine, Pusan National University, Yangsan, Korea (S-O. Nam); Department of Pediatrics, College of Medicine, Chungbuk National University, Chungju, Korea (W-S. Kim); Department of Pediatrics, College of Medicine, Korea University, Ansan, Korea (S-H. Eun); Department of Pediatrics, School of Medicine, Chonnam National University, Gwangju, Korea (Y-O. Kim).
authors.forename: Hee-Jung
authors.initials: HJ
authors.lastname: Chung
authors.affiliation: From the Department of Pediatrics, School of Medicine, Chosun University, Gwangju, Korea (Y-I. Rho); Department of Pediatrics, National Health Insurance Corporation, Ilsan Hospital, Goyang, Korea (H-J. Chung); Department of Pediatrics, College of Medicine, Soonchunhyang University, Seoul, Korea (E-S. Suh); Department of Pediatrics, College of Medicine, Hallym University, Seoul, Korea (K-H. Lee); Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea (B-L. Eun); Department of Pediatrics, School of Medicine, Pusan National University, Yangsan, Korea (S-O. Nam); Department of Pediatrics, College of Medicine, Chungbuk National University, Chungju, Korea (W-S. Kim); Department of Pediatrics, College of Medicine, Korea University, Ansan, Korea (S-H. Eun); Department of Pediatrics, School of Medicine, Chonnam National University, Gwangju, Korea (Y-O. Kim).
authors.forename: Eun-Sook
authors.initials: ES
authors.lastname: Suh
authors.affiliation: From the Department of Pediatrics, School of Medicine, Chosun University, Gwangju, Korea (Y-I. Rho); Department of Pediatrics, National Health Insurance Corporation, Ilsan Hospital, Goyang, Korea (H-J. Chung); Department of Pediatrics, College of Medicine, Soonchunhyang University, Seoul, Korea (E-S. Suh); Department of Pediatrics, College of Medicine, Hallym University, Seoul, Korea (K-H. Lee); Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea (B-L. Eun); Department of Pediatrics, School of Medicine, Pusan National University, Yangsan, Korea (S-O. Nam); Department of Pediatrics, College of Medicine, Chungbuk National University, Chungju, Korea (W-S. Kim); Department of Pediatrics, College of Medicine, Korea University, Ansan, Korea (S-H. Eun); Department of Pediatrics, School of Medicine, Chonnam National University, Gwangju, Korea (Y-O. Kim).
authors.forename: Kon-Hee
authors.initials: KH
authors.lastname: Lee
authors.affiliation: From the Department of Pediatrics, School of Medicine, Chosun University, Gwangju, Korea (Y-I. Rho); Department of Pediatrics, National Health Insurance Corporation, Ilsan Hospital, Goyang, Korea (H-J. Chung); Department of Pediatrics, College of Medicine, Soonchunhyang University, Seoul, Korea (E-S. Suh); Department of Pediatrics, College of Medicine, Hallym University, Seoul, Korea (K-H. Lee); Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea (B-L. Eun); Department of Pediatrics, School of Medicine, Pusan National University, Yangsan, Korea (S-O. Nam); Department of Pediatrics, College of Medicine, Chungbuk National University, Chungju, Korea (W-S. Kim); Department of Pediatrics, College of Medicine, Korea University, Ansan, Korea (S-H. Eun); Department of Pediatrics, School of Medicine, Chonnam National University, Gwangju, Korea (Y-O. Kim).
authors.forename: Baik-Lin
authors.initials: BL
authors.lastname: Eun
authors.affiliation: From the Department of Pediatrics, School of Medicine, Chosun University, Gwangju, Korea (Y-I. Rho); Department of Pediatrics, National Health Insurance Corporation, Ilsan Hospital, Goyang, Korea (H-J. Chung); Department of Pediatrics, College of Medicine, Soonchunhyang University, Seoul, Korea (E-S. Suh); Department of Pediatrics, College of Medicine, Hallym University, Seoul, Korea (K-H. Lee); Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea (B-L. Eun); Department of Pediatrics, School of Medicine, Pusan National University, Yangsan, Korea (S-O. Nam); Department of Pediatrics, College of Medicine, Chungbuk National University, Chungju, Korea (W-S. Kim); Department of Pediatrics, College of Medicine, Korea University, Ansan, Korea (S-H. Eun); Department of Pediatrics, School of Medicine, Chonnam National University, Gwangju, Korea (Y-O. Kim).
authors.forename: Sang-Ook
authors.initials: SO
authors.lastname: Nam
authors.affiliation: From the Department of Pediatrics, School of Medicine, Chosun University, Gwangju, Korea (Y-I. Rho); Department of Pediatrics, National Health Insurance Corporation, Ilsan Hospital, Goyang, Korea (H-J. Chung); Department of Pediatrics, College of Medicine, Soonchunhyang University, Seoul, Korea (E-S. Suh); Department of Pediatrics, College of Medicine, Hallym University, Seoul, Korea (K-H. Lee); Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea (B-L. Eun); Department of Pediatrics, School of Medicine, Pusan National University, Yangsan, Korea (S-O. Nam); Department of Pediatrics, College of Medicine, Chungbuk National University, Chungju, Korea (W-S. Kim); Department of Pediatrics, College of Medicine, Korea University, Ansan, Korea (S-H. Eun); Department of Pediatrics, School of Medicine, Chonnam National University, Gwangju, Korea (Y-O. Kim).
authors.forename: Won-Seop
authors.initials: WS
authors.lastname: Kim
authors.affiliation: From the Department of Pediatrics, School of Medicine, Chosun University, Gwangju, Korea (Y-I. Rho); Department of Pediatrics, National Health Insurance Corporation, Ilsan Hospital, Goyang, Korea (H-J. Chung); Department of Pediatrics, College of Medicine, Soonchunhyang University, Seoul, Korea (E-S. Suh); Department of Pediatrics, College of Medicine, Hallym University, Seoul, Korea (K-H. Lee); Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea (B-L. Eun); Department of Pediatrics, School of Medicine, Pusan National University, Yangsan, Korea (S-O. Nam); Department of Pediatrics, College of Medicine, Chungbuk National University, Chungju, Korea (W-S. Kim); Department of Pediatrics, College of Medicine, Korea University, Ansan, Korea (S-H. Eun); Department of Pediatrics, School of Medicine, Chonnam National University, Gwangju, Korea (Y-O. Kim).
authors.forename: So-Hee
authors.initials: SH
authors.lastname: Eun
authors.affiliation: From the Department of Pediatrics, School of Medicine, Chosun University, Gwangju, Korea (Y-I. Rho); Department of Pediatrics, National Health Insurance Corporation, Ilsan Hospital, Goyang, Korea (H-J. Chung); Department of Pediatrics, College of Medicine, Soonchunhyang University, Seoul, Korea (E-S. Suh); Department of Pediatrics, College of Medicine, Hallym University, Seoul, Korea (K-H. Lee); Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea (B-L. Eun); Department of Pediatrics, School of Medicine, Pusan National University, Yangsan, Korea (S-O. Nam); Department of Pediatrics, College of Medicine, Chungbuk National University, Chungju, Korea (W-S. Kim); Department of Pediatrics, College of Medicine, Korea University, Ansan, Korea (S-H. Eun); Department of Pediatrics, School of Medicine, Chonnam National University, Gwangju, Korea (Y-O. Kim).
authors.forename: Young-Ok
authors.initials: YO
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D006261:Headache / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D009460:Neurologic Examination / Q000379:methods*; D010290:Parents / Q000193:education; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*