Occipital (back of the head) headaches in children

Most children who complain of headaches report pain in the forehead and/or temples. Doctors and parents tend to get more alarmed when a child complains of a headache in the back of the head and such children are more likely to have an MRI scan of the brain. According to a new study published in Neurology, there is no reason for concern.

The researchers examined records of 308 children under 18 (median age was 12) seen at a pediatric neurology clinic and found that 7% of them had pain only in the occipital area, while another 14% had pain in the occipital and another part of the head. The majority of children had migraine headaches. Not surprisingly, more kids with pain in the back of the head had an MRI scan. However, they did not have any more abnormal MRI findings than children with pain in other parts of the head. In fact none of the 4 children in this group who had a serious problem (2 had tumors and 2 had increased pressure) had occipital pain.

Considering that migraine headaches are common in children (4-11% of all kids) there is no need to do MRI scans in all kids with recurrent headaches. The American Academy of Neurology and Child Neurology Society do not recommend a CAT or MRI scan in children with recurrent headaches and a normal neurologic examination. However, 45% of children do get neuroimaging. Imaging is particularly unnecessary if other members of the family suffer from similar headaches.

Neuroimaging is indicated in patients with recurrent headaches and abnormal neurologic examination, seizures, those with recent onset of severe headaches or recent changes in the character of headaches. Changes in the character of headaches may include shift in location, increase in frequency or severity, new associated symptoms such as blurred vision, dizziness, fever, and other.