title: Headache with focal neurologic signs in children at the emergency department.
abstract: OBJECTIVE
  To identify predictors of secondary headache in children consulting at the pediatric emergency department (ED) for headache with a focal neurologic deficit.
  
  
  METHODS
  In this prospective cohort study, we enrolled children aged 6-18 years presenting to the ED of a tertiary care hospital with moderate to severe headache and focal neurologic deficit. Enrollment took place between March 2009 and February 2012. Children with a history of trauma, fever, or neurosurgical intervention were excluded from the study. The final diagnosis was made after 1 year of follow-up. Our primary aim was to identify any differences in the frequency of clinical signs between children with a final diagnosis of primary headache and those with a final diagnosis of secondary headache.
  
  
  RESULTS
  Of the 101 patients included in the study, 66% received a final diagnosis of primary headache (94% migraine with aura), and 34% received a final diagnosis of secondary headache (76.5% focal epilepsy). On multivariate analysis, children with bilateral localization of pain had a higher likelihood (aOR, 8.6; 95% CI, 3.2-23.2; P<.001) of having secondary headache.
  
  
  CONCLUSIONS
  Among children presenting to the ED with focal neurologic deficits, a bilateral headache location was associated with higher odds of having a secondary cause of headache. Additional longitudinal studies are needed to investigate whether our data can aid management in the ED setting.
authors.affiliation: Pediatric Emergency Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France; Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France.
authors.forename: Davide
authors.initials: D
authors.lastname: Massano
authors.affiliation: Pediatric Emergency Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Julliand
authors.affiliation: Department of Radiology, Basildon University Hospital, Essex, United Kingdom.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Kanagarajah
authors.affiliation: Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Gautier
authors.affiliation: Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Vizeneux
authors.affiliation: Pediatric Radiology Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France.
authors.forename: Monique
authors.initials: M
authors.lastname: Elmaleh
authors.affiliation: Pediatric Radiology Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France.
authors.forename: Marianne
authors.initials: M
authors.lastname: Alison
authors.affiliation: Pediatric Emergency Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Lejay
authors.affiliation: Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France.
authors.forename: Silvia
authors.initials: S
authors.lastname: Romanello
authors.affiliation: Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Teisseyre
authors.affiliation: Neurophysiology Unit, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Delanoe
authors.affiliation: Pediatric Emergency Department, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France; Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debré Hospital-Assistance Publique Hôpitaux de Paris, Paris Diderot University, Paris, France. Electronic address: luigi.titomanlio@rdb.aphp.fr.
authors.forename: Luigi
authors.initials: L
authors.lastname: Titomanlio
mesh_terms: D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D051270:Headache Disorders, Primary / Q000175:diagnosis* / Q000453:epidemiology; D051271:Headache Disorders, Secondary / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000175:diagnosis*; D011446:Prospective Studies