Occipital headaches and neuroimaging in children. Neurology 2017 Aug 01;89(5):469-474
Date
07/02/2017Pubmed ID
28667183Pubmed Central ID
PMC5539735DOI
10.1212/WNL.0000000000004186Scopus ID
2-s2.0-85026520201 (requires institutional sign-in at Scopus site) 25 CitationsAbstract
OBJECTIVE: To investigate the common thinking, as reinforced by the International Classification of Headache Disorders, 3rd edition (beta), that occipital headaches in children are rare and suggestive of serious intracranial pathology.
METHODS: We performed a retrospective chart review cohort study of all patients ≤18 years of age referred to a university child neurology clinic for headache in 2009. Patients were stratified by headache location: solely occipital, occipital plus other area(s) of head pain, or no occipital involvement. Children with abnormal neurologic examinations were excluded. We assessed location as a predictor of whether neuroimaging was ordered and whether intracranial pathology was found. Analyses were performed with cohort study tools in Stata/SE 13.0 (StataCorp, College Station, TX).
RESULTS: A total of 308 patients were included. Median age was 12 years (32 months-18 years), and 57% were female. Headaches were solely occipital in 7% and occipital-plus in 14%. Patients with occipital head pain were more likely to undergo neuroimaging than those without occipital involvement (solely occipital: 95%, relative risk [RR] 10.5, 95% confidence interval [CI] 1.4-77.3; occipital-plus: 88%, RR 3.7, 95% CI 1.5-9.2; no occipital pain: 63%, referent). Occipital pain alone or with other locations was not significantly associated with radiographic evidence of clinically significant intracranial pathology.
CONCLUSIONS: Children with occipital headache are more likely to undergo neuroimaging. In the absence of concerning features on the history and in the setting of a normal neurologic examination, neuroimaging can be deferred in most pediatric patients when occipital pain is present.
Author List
Bear JJ, Gelfand AA, Goadsby PJ, Bass NAuthor
Nancy Bass MD Professor in the Neurology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentChild
Child, Preschool
Female
Follow-Up Studies
Headache
Humans
Male
Migraine Disorders
Neuroimaging
Occipital Lobe
Retrospective Studies