ESR Essentials: neuroimaging of pediatric headaches in the emergent and non-emergent setting-practice recommendations by the European Society of Neuroradiology.

This article reviews the key concepts in pediatric headaches and provides a guide for neuroimaging assessment of children (≥ 2 years) and adolescents presenting with this chief complaint in both emergent and non-emergent settings. Contemporary imaging approaches (such as upfront utilization of abbreviated brain MR imaging) have been incorporated in the provided flow charts whenever appropriate. Our aim is to improve patient care and clinical outcomes by identifying the cases that need additional examinations and rapidly depicting any underlying serious disease (especially those requiring acute interventions) while at the same time reducing overuse of neuroimaging (especially irradiating CT) and associated risks and costs, thereby contributing to health system efficiency. KEY POINTS: Clinical history and physical/neurological exam are paramount in the initial evaluation/triage of children with headaches. Imaging should be avoided in children with primary headaches and low-risk mild traumatic brain injury. When imaging is required, prioritize ionization- and sedation-free techniques whenever feasible or minimize radiation dose.