Brain tumors are the second most common malignancy in childhood and the most common solid tumor in children.
Headache is the most common presenting symptom and can occur in isolation, but it is often accompanied by vomiting, unsteadiness, or focal symptoms.
In children, the ability to describe the headache is limited by their developmental stage. Hence, the primary goal is to identify any red flags. Because initial symptoms are nonspecific, either the persistence of the symptoms or additional localizing symptoms should prompt further evaluation. The most sensitive indicator is an abnormal neurologic examination or the development of neurologic symptoms such as double vision, unsteadiness, altered mental status and seizures.
The prevalence of brain tumor in patients with a normal examination and headache history of greater than 6 months is 0.01% to 0.4%. Patients with headaches for less than 6 months and either sleep-related headache, vomiting, confusion, absence of visual aura, absence of family history of migraine, or an abnormal neurologic examination have a brain tumor prevalence of 4%. These numbers might be able to determine the need and urgency to expand an evaluation to include imaging studies such as a Brain MRI, as well as the fact that a delay in diagnosis does not appear to change the long-term morbidity or mortality.
We will discuss imaging modalities for headache in children evaluation in future postings.
REFERENCE: CONTINUUM: Lifelong Learning in Neurology: August 2012 - Volume 18 - Issue 4, Headache
Dr. Germano Falcao
Dr. Germano Falcao is a Mayo Clinic Trained Pediatric Neurologist who has a passion to care for children with neurological disorders and give support to their families. He is a compassionate and experienced physician, a published author, and a professor who specializes in areas involving Seizures and Epilepsy; Headaches and Migraine syndromes; Neurodevelopment Disorders; ADHD and Autism Evaluation.