Bear Joshua J, Gelfand Amy A, Goadsby Peter J, Bass Nancy
From the Section of Child Neurology (J.J.B.), Children's Hospital Colorado, Aurora; Department of Neurology (A.A.G., P.J.G.), University of California, San Francisco; King's College London (P.J.G.), NIHR-Wellcome Trust King's Clinical Research Facility, UK; and Department of Pediatrics (N.B.), Case Western Reserve University, Cleveland, OH.
Neurology. 2017 Aug 1;89(5):469-474. doi: 10.1212/WNL.0000000000004186. Epub 2017 Jun 30.
To investigate the common thinking, as reinforced by the International Classification of Headache Disorders, 3rd edition (beta), that occipital headaches in children are rare and suggestive of serious intracranial pathology.
We performed a retrospective chart review cohort study of all patients ≤18 years of age referred to a university child neurology clinic for headache in 2009. Patients were stratified by headache location: solely occipital, occipital plus other area(s) of head pain, or no occipital involvement. Children with abnormal neurologic examinations were excluded. We assessed location as a predictor of whether neuroimaging was ordered and whether intracranial pathology was found. Analyses were performed with cohort study tools in Stata/SE 13.0 (StataCorp, College Station, TX).
A total of 308 patients were included. Median age was 12 years (32 months-18 years), and 57% were female. Headaches were solely occipital in 7% and occipital-plus in 14%. Patients with occipital head pain were more likely to undergo neuroimaging than those without occipital involvement (solely occipital: 95%, relative risk [RR] 10.5, 95% confidence interval [CI] 1.4-77.3; occipital-plus: 88%, RR 3.7, 95% CI 1.5-9.2; no occipital pain: 63%, referent). Occipital pain alone or with other locations was not significantly associated with radiographic evidence of clinically significant intracranial pathology.
Children with occipital headache are more likely to undergo neuroimaging. In the absence of concerning features on the history and in the setting of a normal neurologic examination, neuroimaging can be deferred in most pediatric patients when occipital pain is present.
探讨《国际头痛疾病分类》第3版（beta版）所强化的一种普遍观点，即儿童枕部头痛罕见且提示存在严重的颅内病变。
我们对2009年转诊至某大学儿童神经科门诊的所有18岁及以下头痛患儿进行了一项回顾性图表队列研究。根据头痛部位对患者进行分层：单纯枕部头痛、枕部合并头部其他部位疼痛或无枕部疼痛。排除神经系统检查异常的儿童。我们评估头痛部位作为是否进行神经影像学检查以及是否发现颅内病变的预测因素。使用Stata/SE 13.0（StataCorp公司，得克萨斯州大学站）中的队列研究工具进行分析。
共纳入308例患者。中位年龄为12岁（32个月至18岁），57%为女性。单纯枕部头痛患者占7%，枕部合并其他部位头痛患者占14%。枕部头痛患者比无枕部疼痛患者更有可能接受神经影像学检查（单纯枕部头痛：95%，相对危险度[RR]10.5，95%置信区间[CI]1.4 - 77.3；枕部合并其他部位头痛：88%，RR 3.7，95% CI 1.5 - 9.2；无枕部疼痛：63%，作为对照）。单纯枕部疼痛或合并其他部位疼痛与具有临床意义的颅内病变的影像学证据无显著相关性。
枕部头痛的儿童更有可能接受神经影像学检查。在病史无相关特征且神经系统检查正常的情况下，大多数枕部疼痛的儿科患者可推迟进行神经影像学检查。
