Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. e12-e17 (doi:10.1542/peds.2008-3150)

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ARTICLE

Headache in Young Children in the Emergency Department: Use of Computed Tomography

Tarannum M. Lateef, MD^a, Mandeep Grewal, BS^a, William McClintock, MD^a, James Chamberlain, MD^b, Himanshu Kaulas, MBBS^a and Karin B. Nelson, MD^a,c

Departments of ^a Neurology
^b Emergency Medicine, Children's National Medical Center and George Washington University School of Medicine, Washington, DC
^c National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland

OBJECTIVE: The goal was to determine whether computed tomographic (CT) scans led to better acute care of young children with headache presenting the emergency department (ED).

METHODS: We examined the records of 364 children 2 to 5 years of age who presented with headache to a large urban ED between July 1, 2003, and June 30, 2006. By reviewing initial history and examination findings, we first identified patients with secondary headaches (ie, with readily identifiable explanations such as ventriculoperitoneal shunts, known brain tumors, or acute illnesses, such as viral syndromes, fever, probable meningitis, or trauma). Charts for the remaining patients were reviewed for headache history, neurologic examination findings, laboratory and neuroimaging results, final diagnosis, and disposition.

RESULTS: On the basis of initial history and physical examination results, 306 children (84%) had secondary headaches. For 72% of those children, acute febrile illnesses and viral respiratory syndromes accounted for the headaches. Among the 58 children (16%) who had no recognized central nervous system disease or systemic illness at presentation, 28% had CT scans performed. Of those, 1 scan yielded abnormal results, showing a brainstem glioma; the patient demonstrated abnormal neurologic examination findings on the day of presentation. For 15 (94%) of 16 patients, the CT scans did not contribute to diagnosis or management. For 59% of children with apparently primary headaches, no family history was recorded.

CONCLUSION: For young children presenting to the ED with headache but normal neurologic examination findings and nonworrying history, CT scans seldom lead to diagnosis or contribute to immediate management.

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Key Words: headache • child • emergency department • computed tomography

Abbreviations: ED—emergency department • CT—computed tomographic

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Accepted Feb 20, 2009.

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