An Evidence-Based Review of Life-Threatening Secondary Headaches in Pediatric Patients in the Emergency Department (Stroke CME and Pharmacology CME) -
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Publication Date: May 2023 (Volume 20, Number 5)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 05/01/2026.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 1 Stroke CME credit and 1 Pharmacology CME credit, subject to your state and institutional approval.

Authors

Sarah Chen, MD

Pediatric Emergency Medicine Fellow, Nationwide Children’s Hospital, Columbus, OH

Aarti Gaglani, MD

Attending Physician, Division of Emergency Medicine, Nationwide Children’s Hospital; Assistant Professor of Pediatrics, The Ohio State University College of Medicine, Columbus, OH

Michael J. Stoner, MD

Chief, Section of Emergency Medicine, Nationwide Children’s Hospital; Associate Professor of Pediatrics, The Ohio State University College of Medicine, Columbus, OH

Peer Reviewers

Sujit Iyer, MD, FAAP

Pediatric Emergency Medicine Faculty, Associate Professor, Pediatrics Fellowship Director, UT Austin Dell Medical School, Dell Children’s Medical Center of Central Texas; National Director of Pediatrics, US Acute Care Solutions, Austin, TX

Emily Rose, MD, FAAP, FACEP

Director for Pre-Health Undergraduate Studies, Associate Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Department of Emergency Medicine, Los Angeles County + USC Medical Center, Los Angeles, CA

Abstract

Headache is a common complaint in pediatric patients presenting to the emergency department. Diagnosis of life-threatening pathology can be difficult due to the nonspecific symptoms for many of these conditions. Emergency clinicians must have a high index of suspicion, obtain a detailed history, and conduct a thorough physical examination to accurately identify life-threatening causes of headache. This issue reviews the general approach, differential diagnosis, and initial workup and management of the most common dangerous causes of secondary headaches in pediatric patients.

Case Presentations

CASE 1

A 4-year-old previously healthy girl is brought into the emergency department by her mother for 6 days of vomiting and headache...

The child has woken up several times over the last week holding her head, crying, and vomiting nonbloody, nonbilious emesis. The girl’s brother is sick with viral gastroenteritis; however, the mother says the girl has not had diarrhea or fever.
The girl’s vital signs are: temperature, 37°C; heart rate, 69 beats/min; respiratory rate, 30 breaths/min; and blood pressure, 120/64 mm Hg.
Your examination is notable for truncal instability when the child attempts to sit up.
What is the next step in your workup?

CASE 2

Your next patient is a 17-year-old girl with sickle cell HbSS who presents with a headache...

The girl describes the headache as being in the back of her head, with sharp, intermittent pain, and she has blurry vision in both eyes. She denies fever, cough, chest pain, or shortness of breath.
What could be causing the girl’s headache? How does the history of sickle cell anemia inform your differential diagnosis and workup?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.