AimHeadaches are a common complaint among children and adolescents, with prevalence rising over the past decades. This study aimed to retrospectively analyze all emergency consultations presenting with headache as the primary symptom at a Level 1 Pediatric Emergency Department (PED) over 7 years, encompassing the COVID-19 pandemic.MethodsAll electronic health records (EHR) of patients aged 2 to 18 years who presented to the PED with non-traumatic headache between January 2018 and December 2024 were retrospectively reviewed. In addition to primary headache diagnoses, conditions commonly associated with headaches were included to identify relevant emergency department cases. Statistical analyses included the chi-square test or Fishers exact test, calculation of Odds Ratios and ANOVA, significant at p < 0.05.ResultsA total of 1278 children and adolescents (564 males, 44.1%; 714 females, 55.9%) with acute headaches visited our PED 1447 times. Of those patients, 668 (46.2%) were diagnosed with primary headaches, 677 (46.8%) with secondary headaches, five (0.3%) with cranial neuropathies and facial pain, and 97 (6.7%) had headaches that could not be clearly classified. Acute headache cases accounted for 3.6% of all PED visits. The largest relative increase compared to the baseline year (2018) was observed in 2023 (+36.2%). Immediate neuroimaging was performed in 19.1% of cases. Red flag symptoms, including systemic symptoms with fever, neoplasm in history, progressive headache, headache associated with severe vomiting and papilledema, were significantly associated with abnormal brain MRI findings. Pharmacological analgesic therapy was administered in 31.9% of cases, and pain assessment was recorded in 46.1% of cases.ConclusionVisits to the PED for headaches are increasing, particularly following the COVID-19 pandemic. The high prevalence of primary headache diagnoses, combined with still insufficient pain management, highlights the need for enhanced education for both pediatricians and parents. For secondary headaches, a thorough headache history focusing on all red flag symptoms, along with a detailed neurological examination assessing clinical features, should form the basis for deciding whether immediate neuroimaging is necessary.Trial registrationThe study has also been officially registered on the public webpage of the German Clinical Trials Registry (GermanCTR) at https://drks.de/search/en/trial/DRKS00036917 (Clinical Trial Number/ DRKS-ID: DRKS00036917, Date of Registration: 2025-05-16, last update: 2025-07-28, registration type: retrospective, status: recruiting complete, study complete).
Zaranek et al. (Sun,) studied this question.