ACUTE HEADACHE AT THE EMERGENCY DEPARTMENT OF A PEDIATRIC HOSPITAL

VILTE C,PASTRANA A,CHAMORRO N,GOMEZ M,ARROYO H.

Objectives: To assess the etiologies of headache seen at an emergency department, to determine the warning signs and symptoms of serious pathology, and to evaluate the usefulness of CT scan.

Material and methods: Records of the emergency department between June 1, 2010 and May 31, 2011 were reviewed. Headache was the chief complaint in 341 patients. To assess outcome, clinical charts were reviewed or follow-up phone calls were made. The 2004 Classification of the International Headache Society was used.

Results: Headache accounted for 0.63% of the consultations with a similar sex ratio. Extracranial infections were found in 37.4% of the patients and headache was isolated (headache without etiology that does not recur within the following 6 months) in 21%. Headaches associated with an underlying disease accounted for 17.8% of all cases. Hydrocephalus was observed in 33.8% of these patients. The events were considered as primary headaches in 14.7%. Fever and  vomiting were seen related to both benign and more serious pathology. Symptoms associated with intracranial disorders were: ataxia, papilledema, sensory disturbances, and hemiparesis. Brain CT scan was performed in 102 children and abnormalities were found in eight: Shunt dysfunction in five, CNS tumors in two, and an arachnoid cyst in one.

Conclusions: The majority of children presenting at the emergency department because of headache do not have serious underlying pathology. A detailed neurologic examination will identify those patients who are at risk of serious pathology and that require imaging studies.

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