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Children with Headache: Evidence-Based Role of Neuroimaging

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Evidence-Based Imaging in Pediatrics

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Key Points

■ Although most headaches in children are benign in nature, a small percentage is caused by serious diseases such as brain neoplasm.

■ Neuroimaging is recommended in children with headache and an abnormal neurologic examination or seizures (moderate evidence).

■ Sensitivity and specificity of MR imaging are greater than CT for intracranial lesions. For intracranial surgical space-occupying lesions, however, there is no difference in diagnostic performance between MR imaging and CT (limited evidence).

■ Conventional CT angiography (CTA) and MR angiography have sensitivities greater than 85% for aneurysms greater than 5 mm. Multidetector CT (MDCT) sensitivity and specificity are greater than 90% for aneurysms greater than 4 mm (moderate evidence).

■ MDCTA and digital subtraction angiography (DSA) have similar sensitivities and specificities for aneurysms >4 mm (moderate evidence).

■ Advance brain imaging may help differentiate the different types of primary headache disorders. Preliminary MRI studies in patients with migraine have demonstrated increased iron levels and increased fMRI activation in the midbrain. PET has demonstrated increased uptake in the hypothalamus and phosphorus MRS has revealed mitochondrial dysfunction in those with cluster headaches (limited evidence).

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Author information

Authors and Affiliations

  1. Co-Director Division of Neuroradiology and Brain Imaging, Director of the Health Outcomes, Policy, and Economics (HOPE) Center, Department of Radiology, Miami Children’s Hospital, 33155, Miami, FL, USA

    L. Santiago Medina

  2. Department of Radiology, Health Outcomes, Policy and Economics (HOPE) Center, Miami Children’s Hospital, 33155, Miami, FL, USA

    Michelle Perez BS, LPN

  3. Department of Neurology, Miami Children’s Hospital, 33155, Miami, FL, USA

    Elza Vasconcellos MD (Director, Headache Disorders Clinic)

Authors
  1. L. Santiago Medina
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  2. Michelle Perez BS, LPN
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  3. Elza Vasconcellos MD
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Corresponding author

Correspondence to L. Santiago Medina .

Editor information

Editors and Affiliations

  1. Dept. Radiology, Miami Children's Hospital, SW 114 Street 7420, Miami , 33156, U.S.A.

    L. Santiago Medina

  2. Dept. Radiology, Riley Children's Hospital, Barnhill Drive 702 , Indianapolis, 46202-5200, U.S.A.

    Kimberly E. Applegate

  3. Harborview Medical Center, University of Washington, Ninth Avenue 325, Seattle, 98104-2499, U.S.A.

    C. Craig Blackmore

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Medina, L.S., Perez, M., Vasconcellos, E. (2010). Children with Headache: Evidence-Based Role of Neuroimaging. In: Medina, L., Applegate, K., Blackmore, C. (eds) Evidence-Based Imaging in Pediatrics. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0922-0_9

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  • DOI: https://doi.org/10.1007/978-1-4419-0922-0_9

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-0921-3

  • Online ISBN: 978-1-4419-0922-0

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