Children with headache: clinical predictors of surgical space-occupying lesions and the role of neuroimaging

Radiology. 1997 Mar;202(3):819-24. doi: 10.1148/radiology.202.3.9051039.


Purpose: To determine clinical predictors useful in differentiation of surgical lesions from medically treated disorders and the role of neuroimaging in children with headache. MATERIALS' AND METHODS: In a 4-year retrospective study, 315 patients with headache and no known neurologic disorder underwent brain magnetic resonance (MR) imaging. Sixty-nine patients also underwent brain computed tomography (CT). Clinical data were correlated with findings from MR imaging and CT and the final diagnosis by means of logistic regression.

Results: Thirteen (4%) patients had surgical space-occupying lesions. Seven independent multivariate predictors of a surgical lesion were identified. Sleep-related headache and no family history of migraine were the strongest predictors. Other predictors included vomiting, absence of visual symptoms, headache of less than 6 months duration, confusion, and abnormal neurologic examination findings. A positive correlation between number of predictors and risk of surgical lesion was noted (P < .0001). No difference between MR imaging and CT was noted in detection of surgical space-occupying lesions, and there were no false-positive or false-negative surgical lesions detected with either modality on the basis of clinical follow-up.

Conclusion: Children at high risk on the basis of these criteria usually require neuroimaging, while children at low risk may be safely followed up clinically without neuroimaging.

MeSH terms

  • Adolescent
  • Adult
  • Arachnoid Cysts / complications
  • Arachnoid Cysts / diagnosis
  • Arachnoid Cysts / diagnostic imaging
  • Arachnoid Cysts / surgery
  • Brain / diagnostic imaging
  • Brain / pathology
  • Brain Diseases / complications
  • Brain Diseases / diagnosis*
  • Brain Diseases / diagnostic imaging
  • Brain Diseases / surgery
  • Brain Neoplasms / complications
  • Brain Neoplasms / diagnosis
  • Brain Neoplasms / diagnostic imaging
  • Brain Neoplasms / surgery
  • Child
  • Child, Preschool
  • Female
  • Headache / etiology*
  • Humans
  • Intracranial Arteriovenous Malformations / complications
  • Intracranial Arteriovenous Malformations / diagnosis
  • Intracranial Arteriovenous Malformations / diagnostic imaging
  • Intracranial Arteriovenous Malformations / surgery
  • Logistic Models
  • Magnetic Resonance Imaging*
  • Male
  • Retrospective Studies
  • Risk Factors
  • Tomography, X-Ray Computed*