Abstract
Objective
This study evaluates neuroimaging findings in pediatric headache patients and identifies clinical predictors for imaging necessity.
Methods
A retrospective analysis was performed on 1008 children aged 3-17 years presenting with headache between January 2023 and January 2025. Data on headache type, neurologic examination, and cranial magnetic resonance imaging (MRI) results were collected and classified per ICHD-3 criteria.
Results
Of the patients, 62.7% were girls and the mean age was 12.4 years. Migraine (27.0%) and tension-type headache (18.6%) were the most common diagnoses. Neurologic examinations were normal in 96.2%. MRI was conducted in 908 patients; 26.7% showed abnormalities, although only 3.6% were clinically significant (eg, pseudotumor cerebri, Chiari malformation). Significant findings correlated with abnormal neurologic examinations and sleep-disrupting headaches (P < .001, P = .0047). Headache duration was not predictive.
Conclusion
Most pediatric headaches are benign. Imaging should be limited to cases with abnormal examinations or clinical red flags.
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