Aims: To determine the prevalence of serious neurological disorders among chil dren with chronic headache. Methods: All children presenting to a specialist hea dache clinic over seven years with headache as their main...Aims: To determine the prevalence of serious neurological disorders among chil dren with chronic headache. Methods: All children presenting to a specialist hea dache clinic over seven years with headache as their main complaint were assesse d by clinical history, physical and neurological examination, neuroimaging where indicated, and by follow up using prospective headache diaries. Results: A tota l of 815 children and adolescents (1.25-18.75 years of age, mean 10.8 years (SD 2.9); 432 male) were assessed. Mean duration of headache was 21.2 months (SD 21 .2). Neuroimaging (brain CT or MRI) was carried out on 142 (17.5%) children. Th e vast majority of patients had idiopathic headache (migraine, tension, or uncla ssified headaches). Fifty one children (6.3%) had other chronic neurological di sorders that were unrelated to the headache. The headache in three children (0.3 7%, 95%CI 0.08%to 1.1%)was related to active intracranial pathology which wa s predictable on clinical findings in two children but was unexpected until a la ter stage in one child (0.12%, 95%CI 0.006%to 0.68%). Conclusions: Chronic h eadache in childhood is rarely due to serious intracranial pathology. Careful hi story and thorough clinical examination will identify most patients with serious underlying brain abnormalities. Change in headache symptomatology or personalit y change should lower the threshold for imaging.展开更多
文摘Aims: To determine the prevalence of serious neurological disorders among chil dren with chronic headache. Methods: All children presenting to a specialist hea dache clinic over seven years with headache as their main complaint were assesse d by clinical history, physical and neurological examination, neuroimaging where indicated, and by follow up using prospective headache diaries. Results: A tota l of 815 children and adolescents (1.25-18.75 years of age, mean 10.8 years (SD 2.9); 432 male) were assessed. Mean duration of headache was 21.2 months (SD 21 .2). Neuroimaging (brain CT or MRI) was carried out on 142 (17.5%) children. Th e vast majority of patients had idiopathic headache (migraine, tension, or uncla ssified headaches). Fifty one children (6.3%) had other chronic neurological di sorders that were unrelated to the headache. The headache in three children (0.3 7%, 95%CI 0.08%to 1.1%)was related to active intracranial pathology which wa s predictable on clinical findings in two children but was unexpected until a la ter stage in one child (0.12%, 95%CI 0.006%to 0.68%). Conclusions: Chronic h eadache in childhood is rarely due to serious intracranial pathology. Careful hi story and thorough clinical examination will identify most patients with serious underlying brain abnormalities. Change in headache symptomatology or personalit y change should lower the threshold for imaging.
