Knowledge of Emergency Department Management of Primary Headache Disorders in Pediatric Patients: Systematic Review

Abstract

Suzan Mohammed Ahmed Hamid*, Dr Mohsin Shahabuddin, Marwa Hussein said Ahmad Alhag, Elsharif A Bazie, Astbraq Alamin Yousef Elhassan, Ranem Abed Nassar Alharbi, Roba Abdullah Ahmed Badri, Hatim Mohamed Ali Elrayyah Hashi, Aisha Hassan Alkuwari, Waheed Ibrahim Alasiri

Background: Primary headache disorders, such as migraine and tension-type headache, are among the most common neurological complaints in Pediatric emergency departments (EDs). Despite their prevalence, management approaches vary significantly, and guideline adherence is inconsistent. Objective: To systematically review and synthesize evidence on the diagnostic and therapeutic management of primary headache disorders in children presenting to the ED.

Methods: A systematic review was conducted following PRISMA 2020 guidelines. Databases including PubMed, Scopus, Embase, and Web of Science were searched from 2000 to 2024. Eligible studies included observational and cohort studies evaluating diagnostic strategies, treatment approaches, and outcomes in Pediatric patients (≤18 years) with primary headache in ED settings.

Results: Fifteen studies (retrospective, cross-sectional, and prospective) were included. Headache was found to be a frequent ED complaint, with migraine accounting for a substantial proportion. Despite this, neuroimaging was often used unnecessarily, with serious neurological pathology present in less than 2% of cases. Evidencebased therapies reduced return visits and improved outcomes, but opioids were still used in some settings. Educational gaps, inadequate classification, and lack of standardized care pathways were common barriers to optimal management.

Conclusion: Current ED management of Pediatric primary headache disorders remains highly variable. Adherence to clinical guidelines, minimizing unnecessary imaging, and implementing provider education and follow-up pathways are essential to improve care quality and outcomes