Clinical scenario

A 10 year old girl has presented on several occasions since a recent head injury with a persistent headache. Clinical examination has previously been documented as normal. You wonder how significant the headache is with respect to the initial head injury.

Three part question

In [a child with a head injury] does [the presence of headache] predict [intracranial injury]?

Search strategies

Medline 1966- Week 4 August 2005 [exp brain injuries/ or brain injur$.mp. or exp craniocerebral trauma/ or head injur$.mp.] AND [exp headache/ or headache.mp.] AND [BestBETs Paediatric filter ] LIMIT to human AND English. Embase 1980–2005 week 37 [craniocerebral trauma.mp. OR exp Head Injury/ OR exp Brain injury/ OR brain injur$.mp] AND [exp headache/ OR headache.mp.] LIMIT to Human, English Language, Abstracts and (infant <to one year> or child <unspecified age> or preschool child <1 to 6 years> or school child <7 to 12 years> or adolescent <13 to 17 years>) The Cochrane Library Issue 3 2005 Exp brain injuries [MeSH] OR exp craniocerebral trauma [MeSH] AND exp headache [MeSH] AND exp Child [MeSH]

Search outcome

Altogether 301 papers were found, of which one was a meta-analysis. One further paper postdated the meta-analysis. These two papers are shown in the table.

Comments

The consensus opinion is that the presence of headache does not correlate with the presence of or severity of intracranial injury in children. Several retrospective studies found high levels of association between extradural haemorrhage and initial presentation symptoms including headache. However, these were a highly selected group of patients and small numbers were involved.

CLINICAL BOTTOM LINE

Headache does not appear to be an independent risk factor for intracranial injury in children.