MRI & CT neuroimaging in children with migraine
Date First Published:
July 7, 2010
Last Updated:
July 15, 2010
Report by:
Leah Gorodi, Medical Student (University of Manchester)
Three-Part Question:
In [children and adolescents with known migraine] is [MRI better than CT] at [ruling out secondary aetiology]?
Clinical Scenario:
A 11 year old girl presents to the Emergency Department with a 2 hour history of a severe throbbing headache. She is a known migraine sufferer, but her headaches have become more frequent in the last 2 months. After history and clinical examination, a diagnosis of migraine is made with possible secondary aetiology. You feel that neuroimaging is appropriate and wonder whether MRI would be better than CT at detecting any abnormalities.
Search Strategy:
Medline 1950-July 2010 using Ovid interface
EMBASE 1980-July 2010 using Ovid interface
Cochrane Database of Systematic Reviews (July 2010)
EMBASE 1980-July 2010 using Ovid interface
Cochrane Database of Systematic Reviews (July 2010)
Search Details:
Medline
[(Exp migraine disorders OR exp Headache OR exp Primary Headache Disorders OR exp Headache Disorders) AND (exp Magnetic Resonance Imaging) AND (exp X-Ray Computed Tomography) AND (LIMIT to English language AND Humans) AND (LMIT to “All Child (0-18 years)”)]
EMBASE
[(Exp migraine aura OR exp migraine without aura OR exp migraine with aura OR exp migraine OR exp headache OR exp primary headache) AND (exp Nuclear Magnetic Resonance Imaging) AND (exp Computerised Tomography) AND (LIMIT to (Human and English Language)) AND (LIMIT to (child <unspecified age> OR preschool child <1 to 6 years> OR school child <7 to 12 years> OR adolescent <13 to 17 years>)(LIMIT to 'clinical query' diagnosis(optimized))
Cochrane Database of Systematic Reviews (July 2010)
Search’migraine’ (ti,ab,kw)
[(Exp migraine disorders OR exp Headache OR exp Primary Headache Disorders OR exp Headache Disorders) AND (exp Magnetic Resonance Imaging) AND (exp X-Ray Computed Tomography) AND (LIMIT to English language AND Humans) AND (LMIT to “All Child (0-18 years)”)]
EMBASE
[(Exp migraine aura OR exp migraine without aura OR exp migraine with aura OR exp migraine OR exp headache OR exp primary headache) AND (exp Nuclear Magnetic Resonance Imaging) AND (exp Computerised Tomography) AND (LIMIT to (Human and English Language)) AND (LIMIT to (child <unspecified age> OR preschool child <1 to 6 years> OR school child <7 to 12 years> OR adolescent <13 to 17 years>)(LIMIT to 'clinical query' diagnosis(optimized))
Cochrane Database of Systematic Reviews (July 2010)
Search’migraine’ (ti,ab,kw)
Outcome:
180 papers found in Medline, 1 was relevant
82 papers found in EMBASE, 1 was relevant
98 papers found in Cochrane, none were relevant
82 papers found in EMBASE, 1 was relevant
98 papers found in Cochrane, none were relevant
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| A Comparative Study of Magnetic Resonance Imaging and Computed Tomography in the Evaluation of Migraine M. J. Kuhn, P. C. Shekar 1990 U.S | 74 patients aged 9-39 years; all had <2yr history of classical migraine & no other significant medical history. | Comparative Study; CT vs MRI | Abnormalities found in MRI & CT scans (compared) in migraine sufferers | Both are useful in detecting abnormalities. 36 patients (49%) abnormalities detected by MRI vs 27 patients (36%) detected by CT. MRI is better than CT. | Weakly relevant to clinical question; adults are included in study as well as children, low quality evidence. Methodology unclear, does not specify how patients have been chosen etc. |
| Clinical Experience on Headache in Children: Analysis of 92 Cases S. Aysun, M. Yetuk 1998 Turkey | 92 patients with headache, migraine was the most frequent cause. | Case series | Efficacy of neuroimaging studies in investigation of headache | % findings relevant to headache; CT 4.2%, MRI 33.3%, Radiography 16%, EEG 25%. MRI has highest yield. | ABSTRACT ONLY. |
Author Commentary:
Both studies provide relaitvely low quality evidence, but both conclude that MRI is better than CT at detecting abnormalities.
Bottom Line:
MRI should be used instead of CT if neuroimaging is required.
References:
- M. J. Kuhn, P. C. Shekar. A Comparative Study of Magnetic Resonance Imaging and Computed Tomography in the Evaluation of Migraine
- S. Aysun, M. Yetuk. Clinical Experience on Headache in Children: Analysis of 92 Cases