MRI for Kids: When is Brain Imaging Necessary?

“Does my child need an MRI” and other frequently asked questions

For some children, simply the idea of a visit to the doctor can cause distress. So how do parents know whether an MRI for kids with migraine is appropriate, especially when it can seem overwhelming even to some grownups? We spoke with Dr. Meghan S. Candee, a pediatric neurologist at University of Utah Health, about when children should get imaging for their migraine.

What to know about brain imaging

Dr. Candee says that most of the time, children with frequent headaches do not require imaging. “The reason for that is that the majority of headaches in children are migraine or tension-type headaches,” she says. These are considered to be primary headache types, ones that can be diagnosed solely from the clinical history and the physical exam. So an MRI is not necessary.

Some parents may think an MRI provides peace of mind, but Dr. Candee says there are many reasons not to perform imaging. These include the cost and contraindications to imaging like braces, which can obscure the quality of the picture.

Also, Dr. Candee says, “Oftentimes when we perform imaging, we find things that we didn’t know were there that are not likely to be the cause of the headache or even associated with the headache, but that can become new sources of anxiety,” she says. Some findings may be normal and only require monitoring but can still cause a parent to worry—and the headache does not get better.

When to use imaging in children

Dr. Candee says she orders imaging on pediatric patients for distinct reasons. For example, she would typically do so when the patient presents a new headache type that is particularly severe. She would order imaging if the headache is occurring in a child that is less than three years old. If a child exhibits symptoms associated with the headache such as changes in vision or swallowing, imaging is necessary. Finally, she would order imaging if an examination comes up with other findings, such as weakness or asymmetries, changes in reflex or how they walk.

In that case, she says, she would order either a CT scan or an MRI for kids and adolescents. “CAT scans are like a black and white TV look at the brain, which is kind of helpful, especially if you’re looking for fractures or blood, especially if there’s been a recent trauma. An MRI is like a high definition plasma TV look at the brain, which is much better for looking at the tissue of the brain, looking for any structural abnormalities that might be causing the head pain, and particularly better at looking at the back part of the brain.”

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