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Review Article Open Access
Background: Headache is a common complaint in children. The study aim was to describe the clinical characteristics on the presentation of patients with headache in the Emergency Department.
Methods: A retrospective longitudinal study of children who presented with headache to a tertiary pediatric hospital in Costa Rica. It was conducted in a twoyear period. We included children from 2 years to 18 years. Data was abstracted from electronic ED records, admission and progress note.
Results: Eighty-eight patients were included in the study. 60% were known to be healthy and 40% had a positive past medical history; 33% had a previous history of migraine or chronic non-specific headache. Forty-one (46, 5%) were diagnosed with primary headache and 47 (53, 5%) with secondary headache. The median time from onset of symptoms to the ED presentation was 120 hours (IQR 24-1440) for patients with primary headache and 72 hours (IQR 24-192) for secondary headache. The median time of duration of headache was 60 minutes in both groups. Patients with primary headache had less neurologic symptoms 4 (9.7%) compared with 8 (17%) in secondary headache. Universal headache was the most frequent location in secondary headache patients (60%). In patients with primary headache, frontal location was more common (46%) followed by universal location (26%). A normal physical examination was noted in 38 (92.6%) of the patients with primary headache in comparison with 27 (57.4%) of secondary headache. The principal diagnosis of patients with primary headache was migraine and in secondary headache a viral infection. CT scans were performed in 76% of the patients; and only 12 (13.6%) were reported as abnormal. 37 (42%) of the patients received medical management.
Conclusions: Routine neuroimaging is not indicated in children with recurrent headache and a normal neurologic examination. Management in the ED must be addressed to establish an accurate diagnosis, excluding secondary causes, using an effective treatment and providing the patients and parents a discharge plan that includes treatment and follow up discharge.
Headache, Emergency department, Pediatric, Children, Migraine, Pediatric Cardiology, Pediatric Critical Care, Pediatric Hematology, Pediatric Pulmonology, Pediatric Endocrinology, Pediatric Nephrology Research, Infection Research, Cold Research, Hepatitis Research, Pneumoniae Research, Malignancy Treatment