Headache in Young Children Almost Never Dangerous

WASHINGTON – The vast majority of headaches in children younger than 8 years old have no dangerous or life-threatening etiology, a retrospective study has shown.

Of 100 children who presented with headache, only 2 had a dangerous condition – brain tumor – and both of those patients also had concerning neurologic symptoms.

The findings should be reassuring not only to parents, but to physicians as well, Dr. Carey Taute said at the annual meeting of the American Headache Society.

"Headache is a very common complaint in the pediatric neurology clinic, emergency department, and pediatric hospital, and everyone is, of course, worried about a dangerous etiology," said Dr. Taute of the Cleveland Clinic. "But in young children, there is a poor ability to get descriptions like the time of onset, duration, location, and nature of pain.

"This can lead to physician uncertainty about how to manage," she added. "Sometimes, this leads to an extensive but unnecessary work-up in these children."

Dr. Taute presented the initial results of 100 patients included in a 300-patient retrospective chart study. The children’s median age was 5 years; gender was evenly split. Most (53%) presented to a pediatric neurology clinic; others presented at a pediatric hospital (27%) and the remainder, to an emergency department.

Of this initial group, nine were excluded from the review because of pre-existing medical conditions, including three with Chiari’s malformation – two of whom had undergone surgical decompression; three with ventriculoperitoneal shunt for hydrocephalus; and three with known brain tumors.

Of the remaining 91 children, 49 were determined to have primary headache. The most common finding was migraine (28), followed by nonclassifiable headache (18), chronic daily headache (2), and one child with tension-type headache.

Secondary headache occurred in 41 of the children. "Of these, the vast majority (37) were attributable to a viral or other illness, but not to any dangerous complications," Dr. Taute said. Physicians couldn’t determine one child’s headache as primary or secondary; that child was referred for brain imaging but did not undergo the test.

A life-threatening cause appeared in only 2 of the 91 children; both of those children had brain tumors. However, both children had concerning neurologic findings. One presented with progressively worse vomiting and falls over a period of a week, and the headache was worse when lying down. The other presented with a head tilt, unilateral increased tone, and unilateral dysmetria.

Overall, primary headache and headache caused by an illness are the most common types of headache in this age group, Dr. Taute said. "Fear of a life-threatening etiology is most often not supported without an abnormal neurologic exam or some concerning neurologic symptoms."

Dr. Taute said she had no relevant financial disclosures.

WASHINGTON – The vast majority of headaches in children younger than 8 years old have no dangerous or life-threatening etiology, a retrospective study has shown.

Of 100 children who presented with headache, only 2 had a dangerous condition – brain tumor – and both of those patients also had concerning neurologic symptoms.

The findings should be reassuring not only to parents, but to physicians as well, Dr. Carey Taute said at the annual meeting of the American Headache Society.

"Headache is a very common complaint in the pediatric neurology clinic, emergency department, and pediatric hospital, and everyone is, of course, worried about a dangerous etiology," said Dr. Taute of the Cleveland Clinic. "But in young children, there is a poor ability to get descriptions like the time of onset, duration, location, and nature of pain.

"This can lead to physician uncertainty about how to manage," she added. "Sometimes, this leads to an extensive but unnecessary work-up in these children."

Dr. Taute presented the initial results of 100 patients included in a 300-patient retrospective chart study. The children’s median age was 5 years; gender was evenly split. Most (53%) presented to a pediatric neurology clinic; others presented at a pediatric hospital (27%) and the remainder, to an emergency department.

Of this initial group, nine were excluded from the review because of pre-existing medical conditions, including three with Chiari’s malformation – two of whom had undergone surgical decompression; three with ventriculoperitoneal shunt for hydrocephalus; and three with known brain tumors.

Of the remaining 91 children, 49 were determined to have primary headache. The most common finding was migraine (28), followed by nonclassifiable headache (18), chronic daily headache (2), and one child with tension-type headache.

Secondary headache occurred in 41 of the children. "Of these, the vast majority (37) were attributable to a viral or other illness, but not to any dangerous complications," Dr. Taute said. Physicians couldn’t determine one child’s headache as primary or secondary; that child was referred for brain imaging but did not undergo the test.

A life-threatening cause appeared in only 2 of the 91 children; both of those children had brain tumors. However, both children had concerning neurologic findings. One presented with progressively worse vomiting and falls over a period of a week, and the headache was worse when lying down. The other presented with a head tilt, unilateral increased tone, and unilateral dysmetria.

Overall, primary headache and headache caused by an illness are the most common types of headache in this age group, Dr. Taute said. "Fear of a life-threatening etiology is most often not supported without an abnormal neurologic exam or some concerning neurologic symptoms."

Dr. Taute said she had no relevant financial disclosures.

WASHINGTON – The vast majority of headaches in children younger than 8 years old have no dangerous or life-threatening etiology, a retrospective study has shown.

Of 100 children who presented with headache, only 2 had a dangerous condition – brain tumor – and both of those patients also had concerning neurologic symptoms.

The findings should be reassuring not only to parents, but to physicians as well, Dr. Carey Taute said at the annual meeting of the American Headache Society.

"Headache is a very common complaint in the pediatric neurology clinic, emergency department, and pediatric hospital, and everyone is, of course, worried about a dangerous etiology," said Dr. Taute of the Cleveland Clinic. "But in young children, there is a poor ability to get descriptions like the time of onset, duration, location, and nature of pain.

"This can lead to physician uncertainty about how to manage," she added. "Sometimes, this leads to an extensive but unnecessary work-up in these children."

Dr. Taute presented the initial results of 100 patients included in a 300-patient retrospective chart study. The children’s median age was 5 years; gender was evenly split. Most (53%) presented to a pediatric neurology clinic; others presented at a pediatric hospital (27%) and the remainder, to an emergency department.

Of this initial group, nine were excluded from the review because of pre-existing medical conditions, including three with Chiari’s malformation – two of whom had undergone surgical decompression; three with ventriculoperitoneal shunt for hydrocephalus; and three with known brain tumors.

Of the remaining 91 children, 49 were determined to have primary headache. The most common finding was migraine (28), followed by nonclassifiable headache (18), chronic daily headache (2), and one child with tension-type headache.

Secondary headache occurred in 41 of the children. "Of these, the vast majority (37) were attributable to a viral or other illness, but not to any dangerous complications," Dr. Taute said. Physicians couldn’t determine one child’s headache as primary or secondary; that child was referred for brain imaging but did not undergo the test.

A life-threatening cause appeared in only 2 of the 91 children; both of those children had brain tumors. However, both children had concerning neurologic findings. One presented with progressively worse vomiting and falls over a period of a week, and the headache was worse when lying down. The other presented with a head tilt, unilateral increased tone, and unilateral dysmetria.

Overall, primary headache and headache caused by an illness are the most common types of headache in this age group, Dr. Taute said. "Fear of a life-threatening etiology is most often not supported without an abnormal neurologic exam or some concerning neurologic symptoms."

Dr. Taute said she had no relevant financial disclosures.