THE VALUE OF BRAIN IMAGING IN CHILDREN WITH HEADACHES

Objective. To determine the value of performing computed tomography (C T) or magnetic resonance imaging (MRI) studies in children with chroni c headaches. Background. Headache is a common complaint in children. W ith the proliferation of brain imaging centers and the increasing pati ent demand for CT or MRI studies, brain imaging has become widely used to evaluate headaches. Methods. A retrospective chart review was cond ucted of all children referred to the pediatric neurology clinic for e valuation of headaches over a 2-year period. Charts were reviewed for headache characteristics, clinical indications for performing CT and M RI studies, and imaging results. Particular attention was paid to evid ence of brain tumors, vascular anomalies, or hydrocephalus. Results. A total of 133 records were studied. Subjects ranged in age from 3 to 1 8 years. Most patients were diagnosed as having either vascular migrai nous headaches (52%) or chronic tension headaches (21%). Other headach e diagnoses were mixed tension-migraine, psychogenic, and post-traumat ic. Headaches were unclassified in 25 patients (19%). Seventy-eight pa tients (59%) had brain imaging: 45 had MRI, 27 had CT, and 6 patients had both. In most cases, brain imaging studies were performed in patie nts with atypical headache pattern, presence of neurologic abnormaliti es during the headache, general symptoms (ie, weight loss or fatigue), or because of parents' or doctors' concerns about brain tumors. Cereb ral abnormalities were found on brain imaging in four patients, but no ne indicated the presence of a treatable disease and all were deemed u nrelated to the presenting complaint. Our findings of no relevant abno rmalities in a series of 78 brain imaging studies indicate that the ma ximal rate at which such abnormalities might appear in this population is 3.8%. Conclusions. These results indicate that brain imaging studi es have very limited value in evaluating headaches in pediatric patien ts without clinical evidence of an underlying structural lesion.