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“Benign” Imaging Abnormalities in Children and Adolescents With Headache
Article first published online: 21 MAR 2006
Headache: The Journal of Head and Face Pain
Volume 46, Issue 3, pages 387–398, March 2006
How to Cite
Schwedt, T. J., Guo, Y. and Rothner, A. D. (2006), “Benign” Imaging Abnormalities in Children and Adolescents With Headache. Headache: The Journal of Head and Face Pain, 46: 387–398. doi: 10.1111/j.1526-4610.2006.00371.x
From the Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH.
- Issue published online: 21 MAR 2006
- Article first published online: 21 MAR 2006
- Accepted for publication September 8, 2005.
- Arnold-Chiari malformation;
- arachnoid cysts;
- magnetic resonance imaging
Objective.—To study the frequency of “benign” abnormalities on brain imaging in children with headache, compare it with the frequency of imaging findings that dictate a change in patient management, and determine the association of benign findings with headache.
Methods.—A database of 681 headache patients from the pediatric outpatient neurology department over 2 years was reviewed. Patients with benign imaging abnormalities were compared to those with nonbenign findings. Benign abnormalities were defined as those that did not result in a change in patient management. Using literature review, we discuss the benign findings and their possible association with headache.
Results.—Two-hundred and forty-one patients (35.4%) had imaging at our facility. Two-hundred and eighteen had brain magnetic resonance imaging and 23 had brain computed tomography (CT) only. Twenty-two patients had CT of the sinuses in addition to brain imaging. Forty-six (19.1%) were found to have 50 benign abnormalities including 13 sinus disease, 11 Chiari I malformations, 7 nonspecific white matter abnormalities, 5 venous angiomas, 5 arachnoid cysts, 4 enlarged Virchow–Robin spaces, 2 pineal cysts, 1 mega cisterna magna, 1 fenestration of the proximal basilar artery, and 1 periventricular leukomalacia. Twenty-three patients (9.5%) had findings requiring a change in management. These included 5 sinus disease, 4 tumors, 4 old infarcts, 3 Chiari I, 2 moyamoya, 1 intracranial vascular stenosis, 1 internal jugular vein occlusion, 1 arteriovenous malformation, 1 demyelinating disease, and 1 intracerebral hemorrhage. When excluding sinusitis, which was evident clinically prior to imaging, 3 patients had absence of abnormal neurologic symptoms and signs and imaging findings that resulted in a change in management.
Conclusions.—Approximately 20% of pediatric headache patients with brain imaging have benign abnormalities that do not result in a change in headache management. Imaging findings that require a change in management are rare in patients with an absence of abnormal neurologic symptoms and signs, occurring in 1.2% of patients imaged in this study.