Headaches in a pediatric emergency department: Etiology, imaging, and treatment

Objective.-To assess the spectrum of diagnoses, the use of CT scans of the brain, and pharmacological treatments in patients presenting to a pediatric emergency department with headaches as the chief complaint. Methods.-A 1-year retrospective chart review of all children who presented to the emergency department,vith a headache as the chief complaint. Results.-One hundred thirty patients (0.7% of all pediatric emergency depar tment visits, mean age = 9.3 years) were included in the study. Primary hea daches included 11 migraine (8.5%) and 2 tension headaches (1.5%). Most of the secondary nonneurological headaches were associated with viral and resp iratory illnesses (n=37, 28.5%), while the majority of the secondary neurol ogical headaches included 26 posttraumatic (20%), 15 possible ventriculoper itoneal shunt malfunctions (11.5%), and 3 cases of aseptic meningitis (2.3% ). The neurological etiology in 9 of these children (6.9%) was found to be serious (subdural hematoma, epidural hematoma, proven ventriculoperitoneal shunt malfunction, brain abscess, pseudotumor cerebri, and aseptic meningit is). Fifteen patients could not be etiologically classified, either because no specific etiology was found or their discharge diagnoses could not clea rly explain the headache. Approximately 10% (5/53) of the CT scans of the h ead that were performed showed new abnormal findings including hydrocephalu s secondary to ventriculoperitoneal shunt malfunction (2), subdural hematom a (1), epidural hematoma (1), and skull fracture (1). Forty-two patients (3 2%) were treated pharmacologically. Thirty-nine of the 42 treated patients (93%) were given over-the-counter analgesics, and 9 (21%) were given prescr ibed analgesics. Conclusions.-The majority of the headaches in the pediatric emergency depar tment were secondary to concurrent illness and minor head trauma, and requi red no pharmacological treatment or only treatment with minor analgesics. I n a small minority of patients, headaches were secondary to serious neurolo gical conditions, which required immediate medical attention. Computed tomo graphy scans showed new abnormalities in a minority of patients and should be reserved for those with neurological diagnoses such as head trauma and v entriculoperitoneal shunt, as well as for those patients,vith recent onset of headaches with no clear etiological explanation, and for those with high -risk medical conditions, such as hypocoagulabilities. Future prospective s tudies are needed to assess the efficacy of the various pharmacological tre atments in this population.