Cerebral MRI and EEG studies in the initial management of pediatric headaches.
OBJECTIVE
High resolution imaging modalities and electroencephalographic studies (EEG) are used in the assessment of children with headaches. We evaluated the role of cerebral MRI (cMRI) and EEG in the initial assessment of children with headache as the chief complaint of initial presentation.


METHODS
A retrospective chart analysis was performed at a tertiary University Hospital.


RESULTS
209 patients were included in this study [mean age 11.3 years; male 91 (43.5%); female 118 (56.5%)]. The following types of headaches were seen: Unclassified headache: 23.4%; probable migraine 17.2%, migraine without aura 13.4%, complicated migraine 12.4%, migraine with aura 1.0%; tension-type 15.3%, and cluster headaches 0.5%, and secondary headaches 16.7%. In 93 children (44.5%) abnormal physical/neurological findings were noted (multiple entries possible). On cMRI studies the following findings were seen: Infection of sinuses (7.2%), pineal cysts (2.4%), arachnoidial cyst and Chiari malformation (1.9%), unspecified signal enhancement (1.0%), and pituitary enlargement, inflammatory lesion, angioma, cerebral ischaemia, and intra-cerebral cyst (each 0.5%). Electroencephalographic findings included both focal and generalised abnormal slowing (5.3%) and Spike-wave complexes (3.3%).


CONCLUSIONS
Despite abnormal findings on neurological/physical examination in a substantial number of children with headaches, the yield of pathological cMRIs was low. The use of EEG recordings was not contributory to the diagnostic and therapeutic approach. More research is needed to better define those patients who are likely to have an intracranial pathology.
University Hospital of Saarland, Department of Neuropediatrics, Homburg, Germany.
Daniel
D
Martens
Isabel
I
Oster
Sven
S
Gottschlling
Panagiotis
P
Papanagiotou
Karin
K
Ziegler
Regina
R
Eymann
Mei-Fang
MF
Ong
Ludwig
L
Gortner
Sascha
S
Meyer
D000293:Adolescent; D016080:Arachnoid Cysts / Q000150:complications / Q000175:diagnosis; D001139:Arnold-Chiari Malformation / Q000150:complications / Q000175:diagnosis; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis; D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D003027:Cluster Headache / Q000150:complications / Q000175:diagnosis; D003937:Diagnosis, Differential; D004569:Electroencephalography; D005260:Female; D006261:Headache / Q000209:etiology*; D051270:Headache Disorders, Primary / Q000150:complications / Q000175:diagnosis*; D006391:Hemangioma / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D020325:Migraine with Aura / Q000150:complications / Q000175:diagnosis; D020326:Migraine without Aura / Q000150:complications / Q000175:diagnosis; D059906:Neuroimaging; D009460:Neurologic Examination; D012189:Retrospective Studies; D018781:Tension-Type Headache / Q000150:complications / Q000175:diagnosis