Document Detail


Headaches in a pediatric emergency department: etiology, imaging, and treatment.
MedLine Citation:
PMID:  10759899     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To assess the spectrum of diagnoses, the use of CT scans of the brain, and pharmacological treatments in patients presenting to a pediatric emergency department with headaches as the chief complaint. METHODS: A 1-year retrospective chart review of all children who presented to the emergency department with a headache as the chief complaint. RESULTS: One hundred thirty patients (0.7% of all pediatric emergency department visits, mean age = 9.3 years) were included in the study. Primary headaches included 11 migraine (8.5%) and 2 tension headaches (1.5%). Most of the secondary nonneurological headaches were associated with viral and respiratory illnesses (n=37, 28.5%), while the majority of the secondary neurological headaches included 26 posttraumatic (20%), 15 possible ventriculoperitoneal shunt malfunctions (11.5%), and 3 cases of aseptic meningitis (2.3%). The neurological etiology in 9 of these children (6.9%) was found to be serious (subdural hematoma, epidural hematoma, proven ventriculoperitoneal shunt malfunction, brain abscess, pseudotumor cerebri, and aseptic meningitis). Fifteen patients could not be etiologically classified, either because no specific etiology was found or their discharge diagnoses could not clearly explain the headache. Approximately 10% (5/53) of the CT scans of the head that were performed showed new abnormal findings including hydrocephalus secondary to ventriculoperitoneal shunt malfunction (2), subdural hematoma (1), epidural hematoma (1), and skull fracture (1). Forty-two patients (32%) were treated pharmacologically. Thirty-nine of the 42 treated patients (93%) were given over-the-counter analgesics, and 9 (21%) were given prescribed analgesics. CONCLUSIONS: The majority of the headaches in the pediatric emergency department were secondary to concurrent illness and minor head trauma, and required no pharmacological treatment or only treatment with minor analgesics. In a small minority of patients, headaches were secondary to serious neurological conditions, which required immediate medical attention. Computed tomography scans showed new abnormalities in a minority of patients and should be reserved for those with neurological diagnoses such as head trauma and ventriculoperitoneal shunt, as well as for those patients with recent onset of headaches with no clear etiological explanation, and for those with high-risk medical conditions, such as hypocoagulabilities. Future prospective studies are needed to assess the efficacy of the various pharmacological treatments in this population.
Authors:
L Kan; J Nagelberg; J Maytal
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Headache     Volume:  40     ISSN:  0017-8748     ISO Abbreviation:  Headache     Publication Date:  2000 Jan 
Date Detail:
Created Date:  2000-07-14     Completed Date:  2000-07-14     Revised Date:  2009-02-02    
Medline Journal Info:
Nlm Unique ID:  2985091R     Medline TA:  Headache     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  25-9     Citation Subset:  IM    
Affiliation:
Division of Pediatric Neurology, Schneider Children's Hospital, Long Island Jewish Medical Center, The Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, NY 11040, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Analgesics / therapeutic use
Child
Child, Preschool
Emergency Service, Hospital* / statistics & numerical data
Female
Headache* / diagnosis,  drug therapy,  epidemiology,  etiology
Humans
Infant
Male
New York / epidemiology
Pediatrics
Retrospective Studies
Tomography, X-Ray Computed / utilization
Chemical
Reg. No./Substance:
0/Analgesics

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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