—We agree with Straussberg that children under 7 years of age with headaches should be evaluated more carefully. Age at onset is one of several criteria that should be used in determining whether or not a neuroimaging study is necessary. However, the information provided by Straussberg is somewhat difficult to interpret. Two of her five patients had an abnormal neurologic examination at presentation and, certainly, would have been imaged by our criteria as well. We are left with three cases of young children with brain tumors presenting with headaches. Of these three cases, one is confusing. It is difficult to believe that a 10-month-old infant presented with an initial complaint of headaches. In our1 one patient with headache onset in the first year of life, headaches were not diagnosed until age 3 years, when the nature of his recurrent episodes became clear. No interval to the diagnosis
Shinnar S, Chu ML. Headaches in Children Younger Than 7 Years: Are They Really Benign?-Reply. Arch Neurol. 1993;50(2):130–131. doi:10.1001/archneur.1993.00540020010004
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