Investigation of Pediatric Headaches

9 May, 2013 by: colinparker

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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


  • 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

[all] Conclusions, goodbye


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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3 Responses to “Investigation of Pediatric Headaches”
  1. Will Sargent says:

    Great topic but I thought your conclusions weren’t in keeping with the discussion I.e. the papers were rubbish but here’s the learning points anyway.
    Really the papers added next to nothing to eminence based practice.
    I had a 13yr old in today with worst ever headache, vomited ten times, looked pale and shitty, all over headache, no phono/photophobia.
    As you did mention, it’s these grey cases we need help in.
    What’s needed?
    Well, a decision rule study, that’s what. A bit of recursive partitioning never did anyone Any harm.

    Also, A bit more about your lit search and a bit more structured critical appraisal.

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