Department of Pediatrics, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyeong-gu, Incheon 21431, Republic of Korea.
Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93, Joongbudae-ro, Paldal-gu, Suwon-si, Gyeonggi-do 16247, Republic of Korea.
Brain Dev. 2022 Sep;44(8):512-519. doi: 10.1016/j.braindev.2022.04.008. Epub 2022 May 11.
Headache is a common complaint in childhood and adolescence. Differentiating benign primary headaches from ominous secondary headaches is often difficult. Clinicians usually seek red flags to determine the need for neuroimaging. We aimed to evaluate the diagnostic values of red flags in pediatric headaches.
We retrospectively reviewed the medical records of 1510 pediatric patients (1470 with primary headache, 40 with secondary headache) presenting with headache and underwent neuroimaging from two centers between March 2010 and December 2019.
The secondary-headache group exhibited significantly higher frequencies of abnormal neurologic signs/symptoms (40.0% vs 6.8%, p < 0.001), Valsalva maneuver/exercise-induced headache (15.0% vs 4.9%, p = 0.004), headache with vomiting (35.0% vs 17.9%, p = 0.006), and onset under age 6 (25.0% vs 10.3%, p = 0.003) than the primary-headache group, with the following positive likelihood ratio (PLR): 5.88, 3.06, 1.96, and 2.42, respectively. The sensitivity values were as follows: abnormal neurologic signs/symptoms (16/40, 40.0%), headache with vomiting (14/40, 35.0%), onset under age 6 (10/40, 25.0%), and Valsalva maneuver/exercise-induced headache (6/40, 15.0%). The overall sensitivity for ominous secondary headaches requiring surgical treatment was 86.2% (25/29).
Certain red flags, including abnormal neurologic signs/symptoms, Valsalva maneuver/exercise-induced headache, headache with vomiting, and onset under age 6, were more prevalent in the secondary-headache group; nonetheless, their sensitivity values and PLR were relatively low. Notwithstanding, considering these red flags' high overall sensitivity for ominous secondary headaches, neuroimaging in patients presenting these red flags should rely on careful follow-up of symptom progression.
头痛是儿童和青少年常见的主诉。将良性原发性头痛与有危险的继发性头痛区分开来通常很困难。临床医生通常会寻找危险信号来确定是否需要神经影像学检查。我们旨在评估危险信号在儿科头痛中的诊断价值。
我们回顾性分析了 2010 年 3 月至 2019 年 12 月期间，两个中心的 1510 例（原发性头痛 1470 例，继发性头痛 40 例）出现头痛并接受神经影像学检查的儿科患者的病历。
继发性头痛组的异常神经系统体征/症状（40.0%比 6.8%，p<0.001）、瓦尔萨尔瓦动作/运动后头痛（15.0%比 4.9%，p=0.004）、伴有呕吐的头痛（35.0%比 17.9%，p=0.006）和发病年龄<6 岁（25.0%比 10.3%，p=0.003）的发生率明显高于原发性头痛组，其阳性似然比（PLR）分别为 5.88、3.06、1.96 和 2.42。其灵敏度值分别为：异常神经系统体征/症状（16/40，40.0%）、伴有呕吐的头痛（14/40，35.0%）、发病年龄<6 岁（10/40，25.0%）和瓦尔萨尔瓦动作/运动后头痛（6/40，15.0%）。需要手术治疗的有危险的继发性头痛的总体灵敏度为 86.2%（25/29）。
某些危险信号，包括异常神经系统体征/症状、瓦尔萨尔瓦动作/运动后头痛、伴有呕吐的头痛和发病年龄<6 岁，在继发性头痛组中更为常见；然而，它们的灵敏度值和 PLR相对较低。尽管如此，考虑到这些危险信号对有危险的继发性头痛的总体高灵敏度，对于出现这些危险信号的患者，神经影像学检查应依赖于对症状进展的仔细随访。
