The Role of Neuroimaging in Diagnosing Pediatric Headaches: Insights From a Large Cohort Study

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.