New practice parameters: what does the evidence say?

The American Academy of Neurology recently has published two practice parameters pertaining to children and adolescents with headache. The first focuses attention on the appropriate evaluation of the child with recurrent headache and reviews the data regarding laboratory investigation, electroencephalography (EEG), and neuroimaging. Routine laboratory investigation and EEG are not recommended. Neuroimaging is not recommended for children with recurring headaches and a normal neurologic examination unless there are historic features to suggest the recent onset of severe headache, change in the type of headache, or associated features that suggest neurologic dysfunction. If there are abnormalities on the neurologic examination (eg, focal findings, signs of increased intracranial pressure, significant alteration of consciousness) or the coexistence of seizures, then neuroimaging is recommended. The second parameter evaluates relevant data regarding the acute and preventive therapies for pediatric migraine.