From the Department of Pediatrics, School of Medicine, Chosun University, Gwangju, Korea (Y-I. Rho); Department of Pediatrics, National Health Insurance Corporation, Ilsan Hospital, Goyang, Korea (H-J. Chung); Department of Pediatrics, College of Medicine, Soonchunhyang University, Seoul, Korea (E-S. Suh); Department of Pediatrics, College of Medicine, Hallym University, Seoul, Korea (K-H. Lee); Department of Pediatrics, College of Medicine, Korea University, Seoul, Korea (B-L. Eun); Department of Pediatrics, School of Medicine, Pusan National University, Yangsan, Korea (S-O. Nam); Department of Pediatrics, College of Medicine, Chungbuk National University, Chungju, Korea (W-S. Kim); Department of Pediatrics, College of Medicine, Korea University, Ansan, Korea (S-H. Eun); Department of Pediatrics, School of Medicine, Chonnam National University, Gwangju, Korea (Y-O. Kim).
Headache. 2011 Mar;51(3):403-408. doi: 10.1111/j.1526-4610.2011.01845.x.
To evaluate the role of neuroimaging and to estimate the prevalence of significant and treatable intracranial lesions in children and adolescents with recurrent headaches.
Neuroimaging studies are commonly performed in children and adolescent patients with headache because of increasing demands by parents and physicians, although objective data and studies to support this widespread practice are minimal.
We retrospectively reviewed the medical records of all 1562 (male 724, female 838) new patients presenting with recurrent headaches to 9 Pediatric Neurology Clinics of tertiary Hospitals. Data regarding age of onset, duration of symptoms before presentation, frequency, duration of each episode, intensity, location and quality of headache, associated neurologic symptoms and a comprehensive neurological examination were obtained for each patient. The International Classification of Headache Disorders, second edition, was used to classify headache types.
Neuroimaging procedures were performed in 77.1% of the patients. Overall, 9.3% (112/1204) of the patients had abnormal findings from neuroimaging. The highest yield was in patients with an abnormal neurological examination wherein abnormal findings on neuroimaging were seen in 50.0% (9/18) of patients (P < .001). The yield was low when imaging was carried out in view of changes in the type of headache (12.9% [26/201]), neurologic dysfunction (10.8% [9/83]), recent onset of severe headaches (7.0% [12/171]), and demands of parent and physicians (10.1% [21/208]). Eleven patients underwent surgery based on neuroimaging results. There was no significant relation between abnormality on neuroimaging and age, sex, headache type, age of onset of headache, duration of symptoms before presentation, duration, frequency, location and intensity of headache (P > .05).
Neuroimaging procedures in children and adolescents with headaches, although not always required, are very commonly performed. We suggest that more strict guidelines for rational use of neuroimaging are needed for pediatric headache patients.
评估神经影像学的作用，并估计反复发作头痛的儿童和青少年中存在显著且可治疗的颅内病变的患病率。
由于家长和医生的需求不断增加，神经影像学检查在儿童和青少年头痛患者中经常进行，尽管支持这种广泛做法的客观数据和研究很少。
我们回顾性分析了 9 家三级医院的 1562 例（男 724 例，女 838 例）新发复发性头痛患儿的病历资料。获取每位患者的发病年龄、就诊前症状持续时间、头痛发作频率、每次发作持续时间、头痛强度、部位和性质、相关神经系统症状以及全面神经系统检查等数据。采用国际头痛疾病分类第 2 版对头痛类型进行分类。
77.1%的患者进行了神经影像学检查。总体而言，1204 例患者中有 9.3%（112/1204）存在神经影像学异常。在神经系统检查异常的患者中，神经影像学异常的检出率最高（50.0%，9/18，P<.001）。在根据头痛类型改变（12.9%，26/201）、神经功能障碍（10.8%，9/83）、新发严重头痛（7.0%，12/171）、家长和医生的要求（10.1%，21/208）进行影像学检查时，检出率较低。11 例患者根据神经影像学结果进行了手术。神经影像学异常与年龄、性别、头痛类型、头痛发病年龄、就诊前症状持续时间、头痛发作频率、持续时间、强度、部位无关（P>.05）。
虽然并非总是需要，但对头痛儿童和青少年进行神经影像学检查非常常见。我们建议需要为儿科头痛患者制定更严格的神经影像学合理使用指南。
