If arteritis is suspected, as can be seen in the setting of sphenoid sinusitis and skull base osteomyelitis, MRA may be helpful. MRV If venous sinus thrombosis is suspected, MRV is indicated. It should be noted, however, that in some cases of infection-induced venous sinus or cavernous sinus thrombosis, contrast-enhanced MRI could be superior to MRV as it shows the cross-sectional area of the vein with direct delineation of the thrombus itself and not just the absence of flow in the lumen, as seen on MRV [53]. The use of contrast in MRV depends on institutional preferences. Arteriography There is usually no role for arteriography in the evaluation of children with headache related to infection. MRI Patients who have a history of subacute or remote trauma may present with headaches. Post-traumatic headache is defined as a headache that begins within 2 weeks of a closed head injury. A prospective study of children admitted with a closed head injury (minor 79%, major 21%) found that 7% of children reported chronic post- traumatic headaches, 4% had episodic tension-type headaches, and 2.5% had migraine without aura [54]. When neurologic signs or symptoms are positive, when headaches are associated with vomiting, or when headaches are increasing in frequency, duration, or severity, regardless of the severity of the initial trauma, neuroimaging, preferably with noncontrast MRI, is indicated. SWI or GRE imaging is helpful in identifying hemosiderin deposition related to prior hemorrhage and should be included in the MRI examination. These sequences are limited because of susceptibility artifact in children with orthodontic braces or other metallic hardware, especially on higher Tesla strength MRI scanners. CT CT is usually not indicated in children with headaches attributed to remote trauma. A retrospective study by Dayan et al [55] identified 2,462 children who had minor blunt head trauma and headaches as their only symptom.
Headache Child PCAs. If arteritis is suspected, as can be seen in the setting of sphenoid sinusitis and skull base osteomyelitis, MRA may be helpful. MRV If venous sinus thrombosis is suspected, MRV is indicated. It should be noted, however, that in some cases of infection-induced venous sinus or cavernous sinus thrombosis, contrast-enhanced MRI could be superior to MRV as it shows the cross-sectional area of the vein with direct delineation of the thrombus itself and not just the absence of flow in the lumen, as seen on MRV [53]. The use of contrast in MRV depends on institutional preferences. Arteriography There is usually no role for arteriography in the evaluation of children with headache related to infection. MRI Patients who have a history of subacute or remote trauma may present with headaches. Post-traumatic headache is defined as a headache that begins within 2 weeks of a closed head injury. A prospective study of children admitted with a closed head injury (minor 79%, major 21%) found that 7% of children reported chronic post- traumatic headaches, 4% had episodic tension-type headaches, and 2.5% had migraine without aura [54]. When neurologic signs or symptoms are positive, when headaches are associated with vomiting, or when headaches are increasing in frequency, duration, or severity, regardless of the severity of the initial trauma, neuroimaging, preferably with noncontrast MRI, is indicated. SWI or GRE imaging is helpful in identifying hemosiderin deposition related to prior hemorrhage and should be included in the MRI examination. These sequences are limited because of susceptibility artifact in children with orthodontic braces or other metallic hardware, especially on higher Tesla strength MRI scanners. CT CT is usually not indicated in children with headaches attributed to remote trauma. A retrospective study by Dayan et al [55] identified 2,462 children who had minor blunt head trauma and headaches as their only symptom.