Neuroimaging findings in pediatric chronic headaches: Is imaging always necessary?

Abstract

Background: Considering the high cost of Magnetic Resonance Imaging and the high risk of radiation exposure to
growing children from Computed tomography scans, we aim to evaluate the neuroimaging findings in children with
chronic headaches, determine the frequency of significant remediable pathologies, and establish the need for
neuroimaging.
Methodology: This is a cross-sectional study of clinical data and neuroimaging findings in 41 children who were
imaged in a tertiary hospital and a private diagnostic center in Abuja on account of chronic headaches. Twenty-two
children were referred for brain Computed Tomography scan while 19 had brain Magnetic resonance Imaging. Collected
data was statistically analyzed using SAS software version 9.3 with the level of significance set at 0.05.
Results: The age range of patients was 4 -18years.Thirty-three patients (80.5%) had chronic primary headaches while
eight (19.5%) patients had additional “red flag” indications. Normal findings and extracranial lesions accounted for
89.5% of MRI (17/19) and 72.7% (16/22) in CT. Intracranial lesions were seen in 75% of patients with “red flag” and
6.1% of patients with primary headaches with significant differences (p=0.0001) between the subsets. The commonest
abnormalities were chronic sinusitis (17.1%) and intracranial tumors (9.6%) with no significant difference in the overall
neuroimaging findings across the age groups. Chronic sinusitis was found predominantly in adolescent females (85.7%).
Conclusions: Neuroimaging has a low yield of significant remediable intracranial lesions in children with chronic
headaches without additional “red flag” symptoms thereby necessitating the call to reconsider the use of neuroimaging
with a view to imaging gently.