#191 An analysis of paediatric headache presentations to the emergency department in children’s health Ireland

<h3>Background</h3> Paediatric headache is a common presentation to the Emergency Department (ED). It is a major cause of morbidity and while generally benign, it can sometimes be a symptom of serious brain pathology. We sought to describe the aetiology and clinical characteristics of patients with non-traumatic headache attending the ED to analyse the management and treatment undertaken. We aimed to identify predictive factors for abnormal neuroimaging from red flag findings in this cohort. <h3>Methods</h3> A retrospective study was conducted over 30 months, including all patients aged 2-18 years who presented to the ED with a primary complaint of non-traumatic headache. Clinical features including red flag findings (vomiting, progressive headache, nocturnal awakening, photo/phonophobia, new focal neurology, gait disturbance, and new visual disturbance) were recorded from history and examination. Investigations and management undertaken for each patient were analysed. Patients with abnormal neuroimaging were identified and the occurrence of red flags was reviewed as compared to those with normal imaging. <h3>Results</h3> A total of 653 patients met the inclusion criteria (55% female, 45% male), while 80% of patients were attending the ED for the first time with a headache. Headache presentations accounted for 0.3% of all presentations to the ED, and 13.7% were admitted to hospital. Serious pathology was identified on 31/653 patients who had neuroimaging (4.7%), with 14 of 193 patients who had a CT brain (7.2%) and 17 of 53 patients who had an MRI Brain (32%). In the analysis of red flags as compared to abnormal neuroimaging, new visual disturbance was the only statistically significant finding. Vomiting was the most common red flag finding seen in those with abnormal neuroimaging. <h3>Conclusion</h3> This large retrospective study highlights the need to develop a comprehensive guideline for paediatric headache in Children’s Health Ireland which considers local resources and policies. Well-designed multi-centre prospective studies are needed to better define the clinical findings that warrant neuroimaging in children with headache and help evaluate further diagnostic values of red flags in this population.