| Abstract [eng] |
Headache in children is one of the most common reasons for emergency department visits, accounting for between 0.19% and 3.8% of all emergency department visits. The most important task for emergency department doctors is to differentiate between primary and secondary headache and to suspect life-threatening secondary headache. However, this is complicated by the high incidence of non-specific red flags, which lead to an excessive amount of neuroimaging. Therefore, the aim of this paper is to perform a systematic review of the scientific literature and to describe the differential diagnosis of pediatric headache in the emergency department by reviewing the etiology, the red flags and their association with neuroimaging, and to discuss the specifics of treatment. To achieve this aim, a search and selection of articles published in the last 10 years was performed using inclusion and exclusion criteria. Recent literature has shown that headache in the pediatric emergency department is mostly secondary to various infections and that life-threatening secondary headache is extremely rare in this population, accounting for between 0.17% and 24.4% of all visits. The most common causes are central nervous system infections, intracranial vascular pathologies and intracranial tumors. In order to differentiate the causes of headache in the paediatric emergency department, it is particularly important to pay attention to the warning symptoms or signs - the red flags. However, due to the high number of non-specific red flags, the incidence of neuroimaging is up to 25 times higher than the incidence of intracranial pathologies diagnosed in the emergency department, so it is important to investigate which flags most accurately alert to life-threatening secondary headache. In the recent literature, abnormal neurological examination, especially ataxia, blurred vision and papilledema, as well as vomiting and recent onset or sudden onset of severe headache, were statistically significantly associated with life-threatening headache. No association was found between life-threatening headache and symptoms previously considered as red flags, such as no family history of primary headache, headache awakening from sleep or recurrent on waking, occipital pain and age <6 years. Treatment in the emergency department depends on the diagnosis, the severity of the headache and and the patient's condition. The most common drugs prescribed in the emergency department were non-steroidal anti-inflammatory drugs and paracetamol. Recent literature has shown that ketorolac and prochlorperazine were the most effective treatments for migraine in the pediatric emergency department. Thus, further studies are needed to investigate the association of red flags with life-threatening headache, as well as monotherapies and combinations of different drugs for the treatment of primary headache, with the aim of discovering a gold standard. |
