MAS Ahmed
Headache can be the initial presentation of brain tumour and patients with headache could be at risk of brain tumour. Depending on neurological examination, headache diagnosis and the presence of Red Flags (RFS), clinicians may arrange urgent or routine Brain Imaging (BI) of children with headache. During prospective period, we carried out 3 studies examining the yield of BI of Neurologically Normal (NN) children with recurrent headaches. In one study, 710 children with headache were classified according to RFs and headache diagnosis. BI of 389/710 children showed significant abnormalities in only 3 children (0.8%). These three children had unclassified headache and RFs. BI was not arranged for the 211/710 children. None of the 211 children developed RFs or abnormal signs on follow�?�up for a mean of 13 months. The second study comprised of 101 NN children with headache on wakening. BI of all children showed no significant intracranial abnormality. All 101 patients had established diagnosis (67 migraine; 16 TTH, 11 medication overuse headaches and 1 sinusitis).The third study consisted of 119 NN children with recurrent side locked unilateral headache. Conclusion and recommendations: Our studies and review of literature, disclose the following key observations: 1) Yield of BI is considerably low if the child is NN, has established headache diagnosis and no RFs: 2) Isolated RFs or UH in children with normal neurological examination and established headache diagnoses should not be regarded as worrisome.