Monday, June 29, 2015

Childhood headache and MRI

Similar to my own experience.  No patient without examination findings had cerebral MRI abnormalities relevant to headache.

Childhood headaches and brain magnetic resonance imaging findings.
Eur J Paediatr Neurol. 2014; 18(2): 163-70 (ISSN: 1532-2130)
Yılmaz Ü; Çeleğen M; Yılmaz TS; Gürçınar M; Ünalp A
BACKGROUND: Headaches are common in children and brain magnetic resonance imaging (MRI) studies are widely used in everyday clinical practice because of increasing demands by parents.
AIM: To determine headache types and to evaluate the frequency and clinical significance of brain MRI abnormalities in children with headache.
METHODS: A total of 449 children (261 male and 188 female with a mean age of 11.16 ± 3.22 years) with headache were included into the study. The criteria defined by International Headache Society were used to classify the headache types.
RESULTS: The causes of headache were migraine in 247 (55.0%), tension-type in 133 (29.6%), secondary in 48 (10.7%), and unspecified headaches in 21 (4.7%) patients. Overall, 324 (72.2%) patients underwent cerebral MRI, which revealed abnormalities in 68 (21.0%) patients. Two (0.6%) patients had cerebral MRI abnormalities relevant to headache, including tumor and hydrocephalus each 1 (0.3%). Twenty-nine (8.9%) patients had incidental cerebral MRI abnormalities including 14 (4.3%) white-matter hyperintensities, 4 (1.2%) old infarcts, 3 (0.9%) Chiari malformations, arachnoid cysts and demyelinating lesions each 2 (0.6%), and subdural hygroma, fibrous dysplasia, pineal cyst and perivascular widening, each 1 (0.3%). Remaining 36 (11.1%) patients had extra-cerebral MRI abnormalities including 34 (10.5%) sinus disease, and 2 (0.6%) adenoid vegetation. Indications for brain MRI were atypical headache pattern or presence of neurologic abnormalities in 59 (18.2%) patients and parents' concerns in 265 (81.8%) patients. The rates of abnormal MRI findings were similar between these 2 groups.
CONCLUSIONS: The most frequent cause of headache in children is migraine. Despite the high rate of imaging abnormalities, the yield of brain MRI is not contributory to the diagnostic and therapeutic approach.
Excerpts from the article:  In the patients with Chiari type I malformation, a neurosurgeon was involved in the evaluation, and headache was not found attributable to Chiari malformation in any of the patients.
While both 2 patients with cerebral abnormalities relevant to headache underwent brain MRI because of the presence of abnormal neurological findings, clinically significant incidental cerebral abnormalities were found in patients underwent brain MRI due to parents' or patients' concerns for an underlying brain disorder.
See here:  Incidental MRI findings in children  April 9,2015

1 comment:

  1. On September 9, 2011, I wrote:
    I have now been practicing for 27 years. I cannot think of a single patient of mine who presented with chronic headaches and had a normal neurological examination who then had a significant abnormality discovered on cerebral imaging. Is this experience typical or atypical?

    A colleague from abroad replied:
    Where is the abnormality? As you know some areas of the brain are silent, and have no manifestations in neurologic exam. Last week I had a 9-year-old boy with headache who had completely normal neurologic exam, but after conducting a neuroimaging a huge brain abscess was revealed in his left frontal lobe.

    Another colleague from a different continent wrote:
    I have the same experience. Children with headache with normal neurological examination (including fundoscopy)and no other complaints never had brain tumour or other space occupying lesion. I am not convinced by our colleague.

    I responded to both:
    Certainly I would not deny that a significant cerebral lesion could be opaque to examination or that there are such patients. My experience would suggest, however, that they are quite rare.