MRI findings in pediatric patients presenting with headache

The majority of headaches in children are of benign primary causes; however, headache secondary to various reasons is also possible. The rationale for imaging in headache is to demonstrate serious and treatable lesions that can be fatal or affect the quality of life. However, the incidence of such lesions is very low in children. In this study, we aimed to evaluate pathologies detected by MRI in pediatric patients applying with isolated headache. MRIs of pediatric patients referred to our department between 2013-2014, with isolated headache and no systemic or neurological symptoms apart from aura were retrospectively evaluated. Out of 447 patients included in the study, 271 (60,6%) were female and 176 (39,4%) were male. Their age varied between 3-18 (average 12.2±3.5). 158 pathologies in 132 patients (29,5%) were detected. 54 (34,2%) white matter lesions, 3 (1,9%) cortical pathologies, 3 (1,9%) basal ganglia lesions, 2 (1,3%) brainstem lesion, 1 (0,6%) cerebellar pathology, 1 (0,6%) malformation, 4 (2,5%) vascular malformations, 2 (1,3%) other vascular pathologies, 53 (33,5%) sinusitis, 8 (5,1%) mastoid inflammation, 7 (4,4%) arachnoid cysts, 10 (6,3%) other cysts and mass lesions, 2 (1,3%) ischemic lesions, 6 (3,8%) variations and 2 (1,3%) ventricular pathologies were detected. There was no difference in age and sex between patients with and without lesions. White matter lesions were more common in children older than 10 whereas sinusitis was more common in children younger than 10 (p= 0,019 and 0,029 respectively). For both pathologies there was no significant difference in sex p=0,708 and 0,968 respectively). There was no significant difference in sex and age for mastoid inflammation, arachnoid cyst and variations. Other pathologies were not evaluated statistically due to small number of cases. MRI demonstrates findings that require treatment or change treatment plan in only a very small number of patients applying with isolated headache. In light of the results of our study and the published literature, we conclude imaging is not beneficial in children with normal neurological examination, no systemic pathologies and with typical history of migraine or tension type headache.