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

L. Santiago Medina, Joseph D. Pinter, David Zurakowski, Ronald G. Davis, Karl Kuban, Patrick D. Barnes

Research output: Contribution to journalArticlepeer-review

108 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)819-824
Number of pages6
Issue number3
StatePublished - Mar 1997
Externally publishedYes


  • Arachnoid, cysts
  • Arteriovenous malformation, cerebral
  • Brain neoplasms
  • Brain neoplasms, MR
  • Brain neoplasms, in infants and children
  • Brain, abnormalities

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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