Of 91 children younger than 8 who presented with headaches, most were diagnosed with primary headaches and only two were diagnosed with a life-threatening etiology.
WASHINGTON, DC—Contrary to a widespread assumption, headache in young children rarely points to a life-threatening underlying condition, according to research presented at the 53rd Annual Scientific Meeting of the American Headache Society.
“Primary headache appears to be the most common headache type in children younger than 8,” said Carey Taute, MD, of the Cleveland Clinic Children’s Hospital. “Our study and others show the fear that headaches in these children are due to life-threatening illness is not supported without an abnormal neurologic exam or neurologic symptoms, as in any other age group.”
Physician uncertainty about headache in young children is widespread and can lead to unnecessarily extensive work-up, according to Dr. Taute and colleagues. Such uncertainty is due, in part, to the fact that the condition is relatively uncommon and often unaccompanied by accurate descriptors or history. In addition, many physicians hold the unsupported assumption that headache in young children indicates a life-threatening illness, Dr. Taute told Neurology Reviews. “This assumption has been touched on in the literature, and it’s very widely observed by many physicians,” she said. “These fears are still widely held despite literature that disproves them.”
To help dispel physician uncertainty, the researchers performed a retrospective analysis of headache etiologies in children younger than 8 who presented to the Cleveland Clinic between 2006 and 2008. They also compared headache etiologies in their cohort with those in previously published studies.
“We wanted to determine the frequency of life-threatening etiologies, because that’s what everyone is so worried about,” said Dr. Taute. “And we wanted to see if there really is cause for concern in the absence of neurologic symptoms or an abnormal neurologic examination.”
The researchers gathered data on about 300 children and have analyzed data on 100 children to date. Among these 100 children, the male-to-female ratio was 1:1, and the mean age was five years. Fifty-three percent of the children presented to Cleveland Clinic’s pediatric neurology practice, 27% to its general pediatric practice, and 17% to its emergency department. Nine children were excluded from analysis because they had pre-existing neurologic conditions.
Of the remaining 91 children, 49 (53.8%) were diagnosed with primary headache, 41 (45%) were diagnosed with secondary headache, and one had a headache that could not be diagnosed as primary or secondary. Among the children with primary headache, 28 (57.1%) had migraine, 18 (36.7%) had nonclassifiable headache, two (4.1%) had chronic daily headache, and one (2%) had tension-type headache. Among the children with secondary headache, 37 (90.2%) had a viral or other nonserious illness, two (4.9%) had brain tumors, one (2.4%) had concussion, and one (2.4%) had pseudotumor cerebri.
The patients with brain tumors had additional signs or symptoms that suggested a life-threatening etiology, Dr. Taute emphasized. “Importantly, both of these children had either neurologic symptoms or an abnormal neurologic exam,” she said. “The first patient presented with vomiting and falls. He had a head tilt, unilateral increased tone, unilateral dysmetria, and a wide-based gait. The second patient did have a normal neurologic exam, but he presented with progressive vomiting, and his headaches were worse when he was lying down.”
Previous studies found similarly low rates of life-threatening or dangerous etiologies in young children with headache, according to the researchers’ literature review. Such etiologies occurred in zero of 104 children younger than 7 in a 1992 study by Chu and colleagues, in 6.9% of 130 children with a mean age of 9 in a 1999 study by Kan and colleagues, in 3% of 105 children younger than 6 in a 2005 study by Raieli and colleagues, and in 0.3% of 364 children younger than 5 in a 2009 study by Lateef and colleagues.
—Jack Baney