Headache with Focal Neurologic Signs in Children at the Emergency Department

• Published in: The Journal of pediatrics 2014-08, Vol.165 (2), p.376-382
• Main Authors: Massano, Davide, MD, Julliand, Sebastien, MD, Kanagarajah, Lakshmi, MD, Gautier, Maxime, MD, Vizeneux, Audrey, MD, Elmaleh, Monique, MD, Alison, Marianne, MD, Lejay, Emilie, MD, Romanello, Silvia, MD, Teisseyre, Laurence, MD, Delanoe, Catherine, MD, Titomanlio, Luigi, MD, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Cohort Studies; Emergency Service, Hospital; Female; Headache Disorders, Primary - diagnosis; Headache Disorders, Primary - epidemiology; Headache Disorders, Secondary - diagnosis; Headache Disorders, Secondary - epidemiology; Headache Disorders, Secondary - etiology; Humans; Male; Nervous System Diseases - diagnosis; Pediatrics; Prospective Studies
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2014.04.053

Objective To identify predictors of secondary headache in children consulting at the pediatric emergency department (ED) for headache with a focal neurologic deficit. Study design In this prospective cohort study, we enrolled children aged 6-18 years presenting to the ED of a tertiary care hospital with moderate to severe headache and focal neurologic deficit. Enrollment took place between March 2009 and February 2012. Children with a history of trauma, fever, or neurosurgical intervention were excluded from the study. The final diagnosis was made after 1 year of follow-up. Our primary aim was to identify any differences in the frequency of clinical signs between children with a final diagnosis of primary headache and those with a final diagnosis of secondary headache. Results Of the 101 patients included in the study, 66% received a final diagnosis of primary headache (94% migraine with aura), and 34% received a final diagnosis of secondary headache (76.5% focal epilepsy). On multivariate analysis, children with bilateral localization of pain had a higher likelihood (aOR, 8.6; 95% CI, 3.2-23.2; P < .001) of having secondary headache. Conclusion Among children presenting to the ED with focal neurologic deficits, a bilateral headache location was associated with higher odds of having a secondary cause of headache. Additional longitudinal studies are needed to investigate whether our data can aid management in the ED setting.