Conti Rosaura, Marta Giorgia, Wijers Lotte, Barbi Egidio, Poropat Federico
Department of Medicine and Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy.
Faculty of Health, Medicine and Life Sciences, Maastricht University, 6211 LK Maastricht, The Netherlands.
Children (Basel). 2023 Feb 13;10(2):366. doi: 10.3390/children10020366.
This study aimed to determine how common are specific red flags of life-threatening headache (LTH) among children with complaints of headache in the emergency department. A retrospective study was conducted over five years, including all patients aged < 18 years who presented for a headache to a Pediatric Emergency Department. We identified patients with life-threatening headaches and compared the recurrence of the main red flags (occipital location, vomit, nocturnal wake-up, presence of neurological signs, and family history of primary headache) to the remaining sample. Two-thousand-fifty-one children (51% female, 49% male) were included. Seven patients (0.3%) were diagnosed with a life-threatening headache. In the analysis of red flags, only the presence of abnormal neurological evaluation and vomiting was found to be more common in the LTH sample. No statistically significant difference was found for nocturnal awakening or occipital localization of pain. Urgent neuroradiological examinations were performed in 72 patients (3.5% of cases). The most common discharge diagnosis was infection-related headache (42.4%), followed by primary headaches (39.7%). This large retrospective study confirms the most recent literature suggesting that night awakenings and occipital pain are common symptoms also associated with not-LTH. Therefore, if isolated, they should not be considered red flags.
本研究旨在确定在急诊科主诉头痛的儿童中，危及生命性头痛（LTH）的特定警示信号有多常见。进行了一项为期五年的回顾性研究，纳入了所有18岁以下因头痛就诊于儿科急诊科的患者。我们识别出患有危及生命性头痛的患者，并将主要警示信号（枕部疼痛部位、呕吐、夜间惊醒、存在神经体征以及原发性头痛家族史）的复发情况与其余样本进行比较。共纳入2551名儿童（51%为女性，49%为男性）。7名患者（0.3%）被诊断为危及生命性头痛。在对警示信号的分析中，仅发现异常神经学评估和呕吐在LTH样本中更为常见。夜间惊醒或疼痛的枕部定位未发现统计学显著差异。72名患者（占病例的3.5%）进行了紧急神经放射学检查。最常见的出院诊断是感染相关性头痛（42.4%），其次是原发性头痛（39.7%）。这项大型回顾性研究证实了最新文献的观点，即夜间惊醒和枕部疼痛也是与非LTH相关的常见症状。因此，如果单独出现，它们不应被视为警示信号。
