■ 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).
Digital Subtraction Angiography Cluster Headache Chronic Daily Headache Pretest Probability Moderate Evidence
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Headache Classification Subcommittee of the International Headache Society. Cephalalgia 2004;24(Suppl 1):1–160.Google Scholar