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Three Part Question

In [children and adolescents with known migraine in occipital region] is [referral to neurology] important to [rule out secondary aetiology]?

Clinical Scenario

A 9 year old girl presents to the Emergency Department with a 2 hour history of a severe throbbing headache that she has described to be at the 'back of her head'. She has experienced headaches in the past, but is unsure if she has always felt it in the same place. After history and clinical examination, a diagnosis of occipital migraine is made. You wonder if you should refer her to neurology for investigation.

Search Strategy

Medline 1950-July 2010 using Ovid interface
EMBASE 1980-July 2010 using Ovid interface
Cochrane Database of Systematic Reviews (July 2010)

Medline
[(Exp migraine disorders OR exp Headache OR exp Primary Headache Disorders OR exp Headache Disorders) AND (exp occipital lobe) AND (exp “Referral and Consultation” OR referral$.mp.) AND (LIMIT to English language AND Humans) AND (LMIT to “All Child (0-18 years)”)]
EMBASE
[(Exp migraine aura OR exp migraine without aura OR exp migraine with aura OR exp migraine OR exp headache OR exp primary headache) AND (exp Occipital Cortex OR exp Occipital Sinus OR exp Occipital Lobe) AND (exp “Patient Referral” OR referral$.m.p.) AND (LIMIT to (Human and English Language) AND (LIMIT to (child OR preschool child <1 to 6 years> OR school child <7 to 12 years> OR adolescent <13 to 17 years>)
Cochrane Database of Systematic Reviews (July 2010)
Search’migraine’ (ti,ab,kw)

Search Outcome

No papers were found in Medline
1 paper was found in EMBASE, it was not relevant
98 papers found in Cochrane, none were relevant

Comment(s)

The IHS states that occipital migraines in children require investigation and follow up to rule out underlying structural abnormalities, however there is no evidence that can be used to decide if a referral to a neurology is necessary in all cases. Research into this area would be beneficial.

Clinical Bottom Line

There is no evidence available as to whether a neurological referral is important for occipital migraines in children and adolescents.