Objective This study evaluates neuroimaging findings in pediatric headache patients and identifies clinical predictors for imaging necessity. Methods A retrospective analysis was performed on 1008 children aged 3-17 years presenting with headache between January 2023 and January 2025. Data on headache type, neurologic examination, and cranial magnetic resonance imaging (MRI) results were collected and classified per ICHD-3 criteria. Results Of the patients, 62.7% were girls and the mean age was 12.4 years. Migraine (27.0%) and tension-type headache (18.6%) were the most common diagnoses. Neurologic examinations were normal in 96.2%. MRI was conducted in 908 patients; 26.7% showed abnormalities, although only 3.6% were clinically significant (eg, pseudotumor cerebri, Chiari malformation). Significant findings correlated with abnormal neurologic examinations and sleep-disrupting headaches ( P < .001, P = .0047). Headache duration was not predictive. Conclusion Most pediatric headaches are benign. Imaging should be limited to cases with abnormal examinations or clinical red flags.
Üstün et al. (Mon,) studied this question.