HEADACHE ETIOLOGY IN A PEDIATRIC EMERGENCY DEPARTMENT

Background: Headache may be the presenting complaint of serious diagno ses such as meningitis, brain tumor, or shunt malfunction, yet no prev ious studies have examined the spectrum of diagnoses for the pediatric emergency department (ED) population with a chief complaint of headac he. Methods: In 1993, 53,988 visits were made to the ED of an urban ch ildren's hospital. Six hundred ninety-six patients (1.3%) had a chief complaint of headache. Half of these visits, distributed randomly thro ughout the year, were chosen for review; total sample size was 288. Re sults: Patient age ranged from two to 18 years (2-5 years, 24.3%; 6-12 years, 57.6%; 13-18 years, 18.1%). The spectrum of ED diagnoses inclu ded viral illness (39.2%), sinusitis (16.0%), migraine (15.6%), post-t raumatic headache (6.6%), streptococcal pharyngitis (4.9%), and tensio n headache (4.5%). No cases of brain tumor or bacterial meningitis wer e identified at the time of ED visit. The only serious neurologic cond itions diagnosed were 15 cases of viral meningitis (5.2%), one shunt m alfunction, one newly diagnosed hydrocephalus, one Burkitt's lymphoma patient with newly diagnosed CNS infiltration, and one punctate hemorr hage post head trauma. Two thirds of patients had radiologic and/or la boratory tests. Positive findings were as follows: 45.6% of sinus radi ographs, 16.3% of rapid streptococcal antigen tests, 60.9% of lumbar p unctures, and 19.0% of brain imaging studies. The frequency of serious and nonserious conditions as a cause of headache was compared to data from general EDs. Conclusion: Serious conditions presenting with the chief complaint of headache in the pediatric ED were not common in our population. The most frequent diagnoses in our review were viral illn ess, sinusitis, and migraine, in contrast to adult studies in which te nsion headache and migraine were most common. Only 6.6% of patients ha d serious neurologic diagnoses, which is in the range reported for gen eral EDs. Of the Serious conditions in our study, 80% were viral menin gitis.