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Episode:

Investigation of Pediatric Headaches
Category: Science & Medicine
Duration: 00:18:08
Publish Date: 2013-05-09 08:49:52
Description:

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In Noggin-cast part 2, we explore the relevant literature with regard to investigating headaches in children.  No magic answers yet, but we discovered a few useful tips along the way… and found a handful of references you can impress your colleagues with.

When faced with a worried family, we all would like to offer the appropriate reassurance, or do the appropriate test – without being too blase or too anxious.  Headaches, in particular, are important because the tests are usually not required, and are either unavailable or potentially harmful.  And if you miss a brain tumour… well, no-one wants that to happen.

Headache evidence-base PEMcast – Outline

Most papers address the same question: are there any clinical features distinguishing the benign from serious causes of headaches?

Kate has picked 2 review papers that have larger numbers of patients, and another 2 which discuss investigating headaches in the Emergency Department.  They’re all pretty short and the abstracts give a reasonable overview…

[cp] Welcome, disclaimer, introductions.

[KB] Conicella 2008 – Intense pain vs moderate, occipital location

[cp] Lewis 2000 – Occipital location, unable to describe / localise

PAWER:

  • Papilloedema
  • Ataxia
  • Weakness
  • Eye movements
  • Reflexes

[WH] Kan 2000 – high CT rate, low analgesia rate

[cp] Lateef 2009 – CT appropriate for life-threatening conditions requiring urgent intervention, radiation risk (see XRayRisk.com)

[all] Conclusions, goodbye

References

Conicella E, Raucci U, Vanacore N, Vigevano F, Reale A, Pirozzi N, Valeriani M.
The child with headache in a pediatric emergency department.
Headache. 2008 Jul;48(7):1005-11.
PubMed PMID: 18705026.

Lewis DW, Qureshi F.
Acute headache in children and adolescents presenting to the emergency department.
Headache. 2000 Mar;40(3):200-3.
PubMed PMID: 10759922.

Kan L, Nagelberg J, Maytal J.
Headaches in a pediatric emergency department: etiology, imaging, and treatment.
Headache. 2000 Jan;40(1):25-9.
PubMed PMID: 10759899.

Lateef TM, Grewal M, McClintock W, Chamberlain J, Kaulas H, Nelson KB.
Headache in young children in the emergency department: use of computed tomography.
Pediatrics. 2009 Jul;124(1):e12-7. doi: 10.1542/peds.2008-3150.
PubMed PMID: 19564257.

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