Back to Home Skip Navigation LinksHome Knowledge Center Pediatric Headache - When to Image
Back to Knowledge Center Results

Pediatric Headache - When to Image

​Pediatric headaches with concurrent symptoms are to be taken seriously, and in some instances, imaging is strongly recommended. When determining whether to refer a patient for diagnostic imaging, consider if the patient has the following:

  • Abnormal neurological exam
  • Thunderclap headache pattern – first or worst headache
  • Immunocompromised
  • Absence of family history
  • Atypical features (age of onset < 6 years, etc.)
  • Refractory headache
  • Headache waking patient from sleep, major exertional or positional changes
  • Occipital headaches
  • Confusion, mental changes, seizures

When referring a patient to imaging, there are four common diagnostic options that look for different concerns in the brain.

  • CT scan: major abnormalities, bleeds
    • Rapid
    • More commonly available
  • MRI: posterior fossa
    • Much more detailed
    • More sensitive for vascular- or infection-neoplasm
    • Bright nonspecific T2 foci common in frequent migraines (sometimes even in general population)
  • MRA: occlusion, vasculitis, RCVS, aneurysms, AVMS, etc.
  • MRV: sinus venous thrombosis, signs of high intracranial pressure (transverse sinus obliteration, sometimes congenital variants)
Physician Education Pediatric Neurology