Pediatric Headache - When to Image
Pediatric headaches with concurrent symptoms are to be taken seriously, and in some instances, imaging is strongly recommended. When determining whether to refer a patient for diagnostic imaging, consider if the patient has the following:
- Abnormal neurological exam
- Thunderclap (high intensity with abrupt onset) headache pattern in first or worst headache
- Immunocompromised
- Absence of family history
- Atypical features (age of onset < 6 years, etc.)
- Refractory headache
- Change in pattern of headaches
- Headache waking patient from sleep or early morning headaches
- Major exertional headaches or positional changes worsen headaches
- Occipital headaches
- Confusion, mental changes, seizures
When referring a patient to imaging, there are four common diagnostic options that look for different concerns in the brain.
- CT scan: major abnormalities, bleeds
- Rapid
- More commonly available
- MRI: posterior fossa
- Much more detailed
- More sensitive for vascular- or infection-neoplasm
- Bright nonspecific T2 foci common in frequent migraines (sometimes even in general population)
- MRA: occlusion, vasculitis, RCVS, aneurysms, AVMS, etc.
- MRV: sinus venous thrombosis, signs of high intracranial pressure (transverse sinus obliteration, sometimes congenital variants)
Physician Education
Pediatric Neurology