ABSTRACT
Patients with suspicious histories or abnormal physical findings need an appropriate workup. For patients with growth delay, or pubertal delay or arrest, medical work-up is indicated. For patients with dermatological examinations that are suspicious of a neurocutaneous disorder, neuroimaging is indicated (magnetic resonance imaging [MRI] with and without contrast, preferred). Sinus tenderness (computed tomography [CT] of the sinuses) or painful, limited jaw opening may warrant further dental investigation. Most patients with CDH have been imaged at some point, as their headache progression went from acute to chronic. The exception would be those patients with new persistent daily headache, where chronic headache started at the onset. Studies of children with recurrent headache with no significant change in severity or frequency over the previous 4 months, and an absence of physical examination abnormalities, do not require further imaging.22 The role of EEGs is similarly not helpful in the vast majority of cases, unless there is a history of an atypical aura or concern over a paroxysmal event.23
