Skip to main content

Advertisement

SpringerLink
Log in

Occipital Headaches and Neuroimaging in Children

  • Childhood and Adolescent Headache (S Evers, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The goal of this review is to outline the prevalence and significance of occipital headaches in children and how they relate to neuroimaging findings. We seek to evaluate the concern that occipital headaches in children are indicative of secondary headache pathology by reviewing the yield of neuroimaging in pediatric patients with occipital headache location.

Recent Findings

Occipital headaches are a common presentation of primary headache disorders in children, seen in 7–16% of children presenting for evaluation of headache and in up to 20% of children diagnosed with migraine in the emergency department. Review of recent literature confirms that in and of itself, occipital location of headache in a child with recurrent headache and a normal physical examination should not be regarded as worrisome. Headaches with associated signs on neurologic examination should be investigated for a secondary cause, regardless of headache location. Occipital headaches that do not meet criteria for a primary headache disorder should be evaluated for site-specific occipital headache conditions. Neuroimaging for recurrent headache in children who have normal neurological examinations has an overall low yield (0–4.1%) for actionable findings in recent studies. Importantly, an abnormal neurologic examination often predicts the presence of neuroimaging abnormalities.

Summary

In the absence of an atypical history or abnormalities on clinical examination, occipital headaches in children are no more likely to be associated with intracranial pathology than headaches in other locations. If the child’s headaches are otherwise consistent with migraine or another primary headache disorder, and the neurologic examination is normal, the yield of neuroimaging is low, and imaging can generally be deferred.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance

  1. •• Headache Classification Committee of the International Headache Society The International Classification of Headache Disorders, 3rd edition. Cephalalgia [Internet]. 2018 Jul 1 38(1):1–211. New headache criteria.

  2. Dodick DW. Clinical clues and clinical rules: primary vs secondary headache. Adv Stud Med. 2003;3(June):550–5.

    Google Scholar 

  3. Kabbouche MA, Cleves C. Evaluation and management of children and adolescents presenting with an acute setting. Semin Pediatr Neurol. 2010;17(2):105–8.

    Article  PubMed  Google Scholar 

  4. Irwin S. When to worry about a migraine and seek emergency medical attention. https://americanmigrainefoundation.org/understanding-migraine/migraine-stroke-heart-disease/. 2016.

  5. Gofshteyn JS, Stephenson DJ. Diagnosis and management of childhood headache. Curr Probl Pediatr Adolesc Health Care. 2016;46(2):36–51.

    Article  PubMed  Google Scholar 

  6. Bonthius DJ, Lee AGHA. Headache in Chidren: approach to evaluatin and general management strategies. Up To Date. 2017;

  7. Lewis DW. Red flags in children who present with headache—how to recognize a serious problem: commentary. Nat Clin Pract Neurol. 2008;4:412–3.

    Article  PubMed  Google Scholar 

  8. •• Genizi J, Khourieh-Matar A, Assaf N, Chistyakov I, Srugo I. Occipital headaches in children: are they a red flag? J Child Neurol. 2017;32(11):942–6. Recent evidence regarding occipital headaches

    Article  PubMed  Google Scholar 

  9. •• Bear JJ, Gelfand AA, Goadsby PJ, Bass N. Occipital headaches and neuroimaging in children. Neurology. 2017;89(5):469–74. Recent evidence regarding occipital headaches.

    Article  PubMed  PubMed Central  Google Scholar 

  10. • Eidlitz-Markus T, Zeharia A, Haimi-Cohen Y, Konen O. Occipital and craniocervical pain and brain MRI in children with migraine. Pediatr Neurol. 2014;50(4):347–52. https://doi.org/10.1016/j.pediatrneurol.2013.11.004.

    Article  PubMed  Google Scholar 

  11. •• Ahmed MAS, Grossman S, Rafique B, Momoh Ojewuyi A. Site locked headaches in paediatric patients do not require routine brain imaging and rarely have a serious aetiology. Acta Paediatr Int J Paediatr. 2017;106(5):791–5. Recent evidence regarding occipital headaches.

    Article  Google Scholar 

  12. Ramirez-Lassepas M, Espinosa CE, Cicero JJ, Johnston KL, Cipolle RJBD. Predictors of intracranial pathologic findings in patients who seek emergency care because of headache. Arch Neurol. 1997;54(12):1506–9.

    Article  PubMed  CAS  Google Scholar 

  13. Lewis DW, Qureshi F. Acute headache in children and adolescents presenting to the emergency department. Headache. 2000;40(3):200–3.

    Article  PubMed  CAS  Google Scholar 

  14. Conicella E, Raucci U, Vanacore N, Vigevano F, Reale A, Pirozzi N, et al. The child with headache in a pediatric emergency department. Headache. 2008;48(7):1005–11.

    Article  PubMed  Google Scholar 

  15. Raza-Knight S, Mankad K, Prabhakar P, Thompson D. Headache outcomes in children undergoing foramen magnum decompression for Chiari I malformation. Arch Dis Child. 2017;102(3):238–43.

    Article  PubMed  Google Scholar 

  16. •• Lewis DW, Ashwal S, Dahl G, Dorbad D, et al. Practice parameter: evaluation of children and adolescents with recurrent headaches: report of the quality standards subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2002;59(4):490–8. Pediatric guidelines for imaging.

    Article  PubMed  CAS  Google Scholar 

  17. • Loder E, Weizenbaum E, Frishberg B, Silberstein S. Choosing wisely in headache medicine: the american headache society’s list of five things physicians and patients should question. Headache. 2013;53(10):1651–9. Headache guidelines.

    Article  PubMed  Google Scholar 

  18. Strain JDACR. Appropriateness criteria on headache-child. J Am Coll Radiol. 2007;4(1):18–23.

    Article  PubMed  Google Scholar 

  19. Frishberg BM, Rosenberg JH, Matchar DB, McCrory DC, Pietrzak MP, Rozen TD, et al. Evidence-based guidelines in the primary care setting: neuroimaging in patients with nonacute headache. Am Acad Neurol [online] http://tools.aan.com/professionals/practice/pdfs/gl0088.pdf. 2000;1–25.

  20. Il RY, Chung HJ, Suh ES, Lee KH, Eun BL, Nam SO, et al. The role of neuroimaging in children and adolescents with recurrent headaches—multicenter study. Headache. 2011;51(3):403–8.

    Article  Google Scholar 

  21. Larson DB, Johnson LW, Schnell BM, Goske MJ, Salisbury SR, Forman HP. Rising use of CT in child visits to the emergency department in the United States, 1995-2008. Radiology. 2011;259(3):793–801.

    Article  PubMed  Google Scholar 

  22. Gilbert JW, Johnson KM, Larkin GL, Moore CL. Atraumatic headache in US emergency departments: recent trends in CT/MRI utilisation and factors associated with severe intracranial pathology. Emerg Med J. 2012;29(7):576–81.

    Article  PubMed  Google Scholar 

  23. Graf WD, Kayyali HR, Alexander JJ, Simon SD, Morriss MC. Neuroimaging-use trends in nonacute pediatric headache before and after clinical practice parameters. Pediatrics [Internet]. 2008;122(5):e1001–5.

    Article  Google Scholar 

  24. Jordan JE. Headache: for the expert panel on neurologic imaging. AJNR Am J Neuroradiol [Internet]. 2007;28(9):1824–6.

    Google Scholar 

  25. Wang H, Simonson T, Greco W, Yuh W. Brain MR imaging in the evaluation of chronic headache in patients without other neurologic symptoms. Acad Radiol. 2001;8(5):405–8.

    Article  PubMed  CAS  Google Scholar 

  26. Vernooij MW, Ikram MA, Tanghe HL, Vincent AJPE, Hofman A, et al. Incidental findings on brain MRI in the general population. N Engl J Med. 2007;357:1821–8.

    Article  PubMed  CAS  Google Scholar 

  27. Maytal J, Patel M, Eviatar L. The value of brain imaging in children with headaches. Pediatrics. 1995;96(3)

  28. Dooley J, Camfield POM, et al. The value of CT scans for children with headaches. Can J Neurol Sci. 1990;17(3):309–10.

    Article  PubMed  CAS  Google Scholar 

  29. Wöber-Bingöl C, Wöber C, Prayer D, Wagner-Ennsgraber C, Karwautz A, Vesely C, et al. Magnetic resonance imaging for recurrent headache in childhood and adolescence. Headache. 1996;36(2):83–90.

    Article  PubMed  Google Scholar 

  30. Chu ML, Shinnar S. Headaches in children younger than 7 years of age. Arch Neurol. 1992;49(1):79–82.

    Article  PubMed  CAS  Google Scholar 

  31. Lewis DW, Dorbad D. The utility of neuroimaging in the evaluation of children with migraine or chronic daily headache who have normal neurological examinations. Headache. 2000;40(8):629–32.

    Article  PubMed  CAS  Google Scholar 

  32. Abu-Arafeh I, Macleod S. Serious neurological disorders in children with chronic headache. Arch Dis Child. 2005;90(9):937–40.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. •• Alexiou GA, Argyropoulou MI. Neuroimaging in childhood headache: a systematic review. Pediatr Radiol. 2013;43(7):777–84. Review of evidence for imaging in headache.

    Article  PubMed  Google Scholar 

  34. Schwedt TJ, Guo Y, Rothner AD. “Benign” imaging abnormalities in children and adolescents with headache. Headache. 2006;46(3):387–98.

    Article  PubMed  Google Scholar 

  35. Scagni P, Pagliero R. Headache in an Italian pediatric emergency department. J Headache Pain. 2008;9(2):83–7.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Goldstein J, Camargo C, Pelletier A, Edlow J. Headache in United States emergency departments: demographics, work-up and frequency of pathological diagnoses. Cephalalgia. 2006;26(6):684–90.

    Article  PubMed  CAS  Google Scholar 

  37. Ahmed MAS, Martinez A, Cahill D, Chong K, Whitehouse WP. When to image neurologically normal children with headaches: development of a decision rule. Acta Paediatr Int J Paediatr. 2010;99(6):940–3.

    Article  CAS  Google Scholar 

  38. Whitehouse A, Momoh-Ojewuyi A, Abusamara R, Al-Ani S, Alkilani R, Ahmed M. Occipital locked headache. J Headache Pain. 2013;14(S1):P181.

    Article  PubMed Central  Google Scholar 

  39. Hsiao HJ, Huang JL, Hsia SH, Lin JJ, Huang IA, Wu CT. Headache in the pediatric emergency service: a medical center experience. Pediatr Neonatol. 2014;55(3):208–12.

    Article  PubMed  Google Scholar 

  40. Yilmaz Ü, Çeleǧen M, Yilmaz TS, Gürçinar M, Ünalp A. Childhood headaches and brain magnetic resonance imaging findings. Eur J Paediatr Neurol. 2014;18(2):163–70.

    Article  PubMed  Google Scholar 

  41. Kan L, Nagelberg J, Maytal J. Headaches in a pediatric emergency department: etiology, imaging, and treatment. Headache. 2000;40(1):25–9.

    Article  PubMed  CAS  Google Scholar 

  42. Tsushima Y, Endo K. MR imaging in the evaluation of chronic or recurrent headache. Radiology. 2005;235(2):575–9.

    Article  PubMed  Google Scholar 

  43. Jordan JE, Ramirez GF, Bradley WG, Chen DY, Lightfoote JB, Song A. Economic and outcomes assessment of magnetic resonance imaging in the evaluation of headache. J Natl Med Assoc. 2000;92(12):573–8.

    PubMed  PubMed Central  CAS  Google Scholar 

  44. The Childhood Brain Tumor Consortium. The epidemiology of headache among children with brain tumor. Headache in children with brain tumors. The childhood brain tumor consortium. J Neurooncol. 1991;10(1):31–46.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The University of California, San Francisco (UCSF), Department of Neurology, Pediatric Brain Center, Child & Adolescent Headache Program, Mission Hall, Box 0137, 550 16th Street, 4th Floor, San Francisco, California, 94158, USA

    Samantha L. Irwin & Amy A. Gelfand

Authors
  1. Samantha L. Irwin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amy A. Gelfand
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samantha L. Irwin.

Ethics declarations

Conflict of Interest

Dr. Samantha Irwin is the co-founder and CEO of a company named HeadSoothe Nutraceuticals Inc. which is working to develop a combination nutraceutical for the treatment of headache in children. This company is not associated with this work. Dr. Amy Gelfand has received honoraria from UpToDate and consulting fees from Zosano, Eli Lilly, and Biohaven. eNeura provides consulting payments for work done by Dr. Gelfand to the UCSF Pediatric Headache program. Her spouse receives consults for Genentech, research support from Genentech, Quest Diagnostics and MedDay, and personal compensation for medical-legal consulting.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Childhood and Adolescent Headache

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Irwin, S.L., Gelfand, A.A. Occipital Headaches and Neuroimaging in Children. Curr Pain Headache Rep 22, 59 (2018). https://doi.org/10.1007/s11916-018-0712-6

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11916-018-0712-6

Keywords

Search

Navigation