The Australia and New Zealand Child Neurology Society
The Australia and New Zealand Child Neurology Society (ANZCNS) is a collaborative group of medical professionals working in the field of paediatric neurology or in allied neurosciences who are working to advance the science of paediatric neurology and advocate for improved care for young people with neurological disorders.
4.
Do not routinely undertake neuroimaging for new onset primary headache without first examining for neurological abnormality.
Most headaches are attributable to benign conditions. Studies suggest that the yield of neuroimaging findings in children with headache that actually change patient management is no higher than 2.5 per cent. This supports the practice of selective imaging of paediatric headache patients with clinical presentation suspicious for intracranial abnormality.
Moreover, the routine use of neuroimaging may lead to the discovery of incidental benign abnormalities, which may cause undue alarm, and headaches may be wrongfully attributed to these incidental findings. For instance, a retrospective study revealed benign neuroimaging abnormalities in approximately 20 per cent of paediatric headache patients who underwent neuroimaging. Neuroimaging on a routine basis is therefore not indicated in children with new onset primary headaches and a normal neurological examination. It should be reserved for a selected group.
Supporting evidence
- Alexiou GA, Argyropoulou MI. Neuroimaging in childhood headache: a systematic review. Pediatr Radiol 2013; 43:777–84.
- Clarke CE, Edwards J, Nicholl DJ, et al. Imaging results in a consecutive series of 530 new patients in the Birmingham Headache Service. J Neurol 2010; 257(8):1274-8.
- Schwedt TJ, Guo Y, Rothner D, et al. "Benign" imaging abnormalities in children and adolescents with headache. Headache 2006; 46(3):387-98.
How this list was made
Following deliberations, the ANZCNS Board determined to investigate the evidence for nine priority recommendations regarding low-value clinical practices in paediatric neurology. An evidence review was developed for these recommendations and served as the basis for an online survey sent to all ANZCNS members asking respondents if they agreed, disagreed or were unsure if these recommendations were evidence based, undertaken in significant numbers, and important in terms of reducing patient harm and unnecessary healthcare expenditure. Based on survey responses, each of the nine was assigned a score and ranked accordingly. Based on this information and a final evidence review, these top 5 recommendations were chosen.
Related recommendations
- 1 Do not routinely perform electroencephalographs (EEGs) for children presenting with febrile seizures.
- 2 Do not routinely perform computed tomography (CT) scanning of children presenting with new onset seizures.
- 3 Do not routinely undertake repeat blood level monitoring of antiepileptic drug (AED) treatments.
- 4 Do not routinely undertake neuroimaging for new onset primary headache without first examining for neurological abnormality.
- 5 Do not routinely perform electroencephalographs (EEGs) for children presenting with syncope (fainting).