THE ROLE OF NEURORADIOLOGY ON THE HEADACHES IN CHILDREN

THE ROLE OF NEURORADIOLOGY ON THE HEADACHES IN CHILDREN IL RUOLO DELLA NEURORADIOLOGIA NELLE CEFALEE DELL’ETA’ EVOLUTIVA E.Tozzi, M.Gallucci Clinica Pediatrica, UO di Neuroradiologia Università degli studi L’Aquila etozzi@univaq.it Several Authors studied correlation between the neuroimaging and the headaches. The studies has been used as in order to give the comprehension pathogenetical mechanisms of migraine, as to give informations to physician and neurologist. Concerning the diagnostics of headache, an EFNS Task Force evaluated recently the usefulness of imaging procedures in non-acute headache patients on the basis of evidence from the literature and defined guidelines on when to use magnetic resonance imaging or computed tomography.[1,3] MR techniques has been used: Bold-f MRI (blood oxygen level dependent functional MRI,), MR spectroscopy, Diffuse-weighted and perfusion weighted MRI. Until now the number of studies has been too small to establish an optimal protocol. There are no studies concerning the repeatability of functional MR technique and there are no studies correlating results with those obtained from electrophysiological techniques. Bold – f MRI signal ,marker of neuronal activation, explored the visual cortex in migraine with aura. Magnetic resonance spectroscopy studies are compatible with an abnormal energy metabolism and abnormal magnesium concentrations. Diffusion weighted MRI studies found abnormalities of white matter which were mild compared with other diseases. The first PET study scanned during spontaneous migraine attacks, revealed brainstem activation. Voxel-based morphometry showed in cluster headache a significant unilateral increase of grey matter in the posterior and inferior hypotalamus and in the pain matrix in TTH.[3] Appropriate selection of patients with headache for neuroimaging to look for secondary causes is very important. Red flags act as screening tools to help in identifying those patients presenting with headache who would benefit from prompt neuroimaging, and may increase the yield. Three red flag features proved to be statistically significant with the p-value of less than 0.05 on both univariate and multivariate analysis. These were: paralysis; papilloedema; and "drowsiness, confusion, memory impairment and loss of consciousness". The changing pattern of headache, fluctuating between tension headache, migraine, and non-specific symptoms should lower the threshold for neuroimaging. Investigations of adult patients with chronic headache and normal physical examination have shown that atypical headaches are associated with increased risk of finding MRI abnormalities (14.1%) compared to those with migraine (0.6%) or tension headache (1.4%). [2] Abnormal neurological examen is the sign more important and more predictable to brain lesion in headache.