The recent review by Jang et al. [1] confirms a low prevalence of significant intracranial abnormalities found in adult patients with headache, as documented in existing literature.In our third-level Child Neurology and Psychiatry Unit we do not have an Emergency Department, but patients with headache are quite often seen as outpatients sent by their general paediatrician with a priority access (“deferred urgency”). When deemed necessary after first clinical assessment by the child neuropsychiatrist, these children can be hospitalized to undergo a full evaluation.In 2017, eighty-four patients (mean age 11 years old) were hospitalized for this reason. They received an in-depth physical examination for associated neurological and psychiatric problems and a detailed history was taken to assess headache frequency; they also underwent different instrumental exams (chosen according to clinical data) and all of them underwent brain-MRI to clarify their diagnosis.The patients’ clinical diagnosis (according to the ICHD III) were: tension-type headache 46%, migraine with aura 17% and without aura 21%, headache with mixed characteristics 12%, cluster headache 4%. Comorbidities were present in 37.5% of patients: psychiatric 44%, both psychiatric and neurological 34%, general medicine comorbidities 22%. Brain MRI showed normal findings in 70.3% of patients, anatomical variants in 8.3%, findings of uncertain pathological significance in 19% and pathological alterations in about 2.4% (1 case of pseudotumor and 1 of cerebellar astrocytoma correlated with headache). Ear, Nose, Throat (ENT) disorders were documented in 24% of ACCESSpatients: 5% nasopharynx hypertrophy, 19% paranasal sinus disease, 5% mastoid involvement.These data are interesting for two main reasons. First, it is important to highlight that 24% had ENT disorders not detected during clinical assessment; it is worth noting that these unrecognized ENT disorders were easily treatable (at follow up, this treatment also produced a cessation of headache). This means that for these patients MRI was in fact an exam that changed the treatment prescribed and/or increased it effectiveness. Second, the prevalence of significant alterations in our study was lower than the usually reported [2].Jang et al. [1] describe the existing concerns about performing unnecessary neuroradiological exams. This poses serious ethical concerns, given on one hand the importance of the early identification of potentially life-threatening diseases and on the other hand the cost of these procedures both for the child (procedural sedation, X-rays in the case of CT) and for the health system. Moreover, inconsequential findings can lead to further unnecessary examinations and can be used as a defence to avoid the exploration of other potentially relevant factors, such as the psychological functioning of the child [3,4]. This is especially important because of the relevance of psychological factors for treatment and prognosis of childhood headache is well established [5].Our data support the need of robust prospective studies to better define clinical factors predicting (or excluding) the utility of MRI in children and adolescents with headache.