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Three Part Question

In [a child with a head injury] does [the presence of headache] predict [intracranial injury]?

Clinical Scenario

A ten year old girl has presented on several occaisons since a recent head injury with a persistent headache. Clinical examination has previously been documented as normal. You wonder how significant the headache is with respect to the initial head injury.

Search Strategy

Medline 1966- Week 4 August 2005
Embase 1980–2005 week 37
The Cochrane Library Issue 3 2005
Medline:[exp brain injuries/ or brain injur$.mp. or exp craniocerebral trauma/ or head injur$.mp.] AND [exp headache/ or headache.mp.] AND [BestBETs Paediatric filter ] LIMIT to human AND English.
Embase: [craniocerebral trauma.mp. OR exp Head Injury/ OR exp Brain injury/ OR brain injur$.mp] AND [exp headache/ OR headache.mp.] LIMIT to Human, English Language, Abstracts and (infant or child or preschool child <1 to 6 years> or school child <7 to 12 years> or adolescent <13 to 17 years>)
The Cochrane Library: Exp brain injuries [MeSH] OR exp craniocerebral trauma [MeSH] AND exp headache [MeSH] AND exp Child [MeSH]

Search Outcome

Altogether 301 papers were found, of which one was a meta-analysis. One further paper postdated the meta-analysis. These two papers are shown in the table.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Dunning J et al, 2004, UK	1136 children reported in 4 studies	Meta-analysis	Relative risk of intracranial haemorrhage in children with headache	1.02 (CI 0.62–1.69)
Chan HC et al, 2005, Malaysia	265 children aged 2–18 years admitted to hospital with head injury	Prospective cohort	Odds ratio of intracranial injury	20.8 (CI 3.9–25.2)	Only children admitted to hospital

Comment(s)

The consensus opinion is that the presence of headache does not correlate with the presence of or severity of intracranial injury in children. Several retrospective studies found high levels of association between extradural haemorrhage and initial presentation symptoms including headache. However, these were a highly selected group of patients and small numbers were involved.

Clinical Bottom Line

Headache does not appear to be an independent risk factor for intracranial injury in children.

References

1. Dunning J, Batchelor J, Stratford-Smith P. et al. A meta-analysis of variables that predict significant intracranial injury in minor head trauma. Arch Dis Child 2004;89:653–59.
2. Chan HC, Aasim WAW, Abdullah NM. et al. Characteristics and clinical predictors of minor head injury in children presenting to two Malaysian accident and emergency departments. Singapore Med J 2005;46:219–23.