HEADACHE AS AN ALARM SIGN FOR PEDIATRIC EMERGENCY (Atena Editora)

Abstract

Headache is one of the most frequent causes of admission to

pediatric emergency department. In childhood, it presents a wide spectrum of etiologies, from benign to clinical conditions with a poor prognosis, such as those secondary to tumors and cerebral vascular malformations. In view of this, this study aims to systematize the factors that make headache in pediatrics a sign of medical emergency, distinguishing it from self-limiting conditions with less potential severity. For that, an integrative review with a qualitative approach was carried out through a literature review in medical textbooks and in Pubmed/Medline, Scielo, BVS and Google Scholar in May 2023. Some red flags cited in the studies were pain that wakes the patient up during the night, or appears soon after awakening, associated vomiting, occipital location, visual distortion, signs abnormal neurological signs and precipitation by the Valsalva maneuver. These findings could be evaluated regarding their association with more severe conditions that require neuroimaging evaluation for specific treatment. Clinical suspicion is commonly guided by warning signs and what

tend to be present in the most significant conditions, however, the possible inaccuracy of the report of children and the prevalence of these signs in benign and self-limiting conditions seem to reduce their sensitivity and specificity.

Thus, it is imperative that the emergency professional perform a detailed anamnesis, examining the patient carefully in search of warning signs and requesting additional tests, if necessary, to determine the etiologic diagnosis. In addition, more careful management is needed with regard to red flags in headache cases, as well as further studies that correlate the symptomatology with the pathophysiology of potentially life-threatening diseases or poor prognosis.