title: Delayed diagnosis in pediatric headache: an outpatient Italian survey.
abstract: OBJECTIVE
  The aim of this prospective study is to assess the time lapse between the onset of recurring headache and the correct diagnosis in a cohort of pediatric patients attending an Italian children's headache center for the first time.
  
  
  METHODS
  One hundred and one patients and parents, referred to the Pediatric Headache Centre of San Raffaele Hospital in Milan, Italy, underwent a semi-structured interview to ascertain features of headache since onset (clinical and family history, presence of childhood periodic syndromes, previously undergone instrumental exams and specialists' examinations before the correct diagnosis, past and current treatment). All patients were evaluated by expert neurologists and their headache was classified according to the International Classification of Headache Disorders II (2004).
  
  
  RESULTS
  The median time delay from the onset of the first episode of recurrent headache to definite diagnosis was 20 months (interquartile range 12 to 36 months). A correlation with younger age and a more delayed headache diagnosis was found (r Spearman = 0.25; P = .039). An association between diagnostic delay and positive family history (median 24 months [12 to 48] vs 12 [6 to 24]; P = .014) or female gender (median 18 months [12 to 42] vs. 12 [5 to 30]; P trend = .070) was also evident. Notably, 76 out of 101 patients referred to our Center received an appropriate diagnosis according to International Classification of Headache Disorders II at the time of our visit only. Of note, up to 21% of this group were previously misdiagnosed (for epilepsy 43%, sinusitis 38%, or other diseases 19%), a fact that contributed to a longer time of clinical assessment (median 39 months) before reaching a correct diagnosis. The other group of 80 patients (79%) did not receive a specific diagnosis and treatment, and were not studied until their symptom became chronic and disabling.
  
  
  CONCLUSIONS
  Pediatric headache is still under-diagnosed and not adequately considered as a health problem in the medical community as well as social settings. There is a need for educational programs regarding headache involving not only general practitioners, pediatricians, and neurologists, but also the general population. These are desirable in order to raise awareness of such a condition and, accordingly, treat children accurately.
authors: Department of Neurology, Headache Center, INSPE, San Raffaele Hospital Scientific Institute, Vita-Salute University, Milano, Italy.
authors: Bruno
authors: B
authors: Colombo
authors: Dacia
authors: D
authors: Dalla Libera
authors: Donatella
authors: D
authors: De Feo
authors: Giulia
authors: G
authors: Pavan
authors: Pietro Osvaldo
authors: PO
authors: Annovazzi
authors: Giancarlo
authors: G
authors: Comi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D006261:Headache / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D007407:Interviews as Topic / Q000379:methods; D007558:Italy; D008297:Male; D009460:Neurologic Examination; D010045:Outpatients / Q000706:statistics & numerical data*; D010372:Pediatrics; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013997:Time Factors