Cefalea en la infancia: enfoque diagnóstico basado en signos de alarma
DOI:
https://doi.org/10.66104/k4778h20Palabras clave:
Cefalea pediátrica; Signos de alarma; Cefalea secundaria; Cefalea primaria; Neuroimagen; Migraña; Hipertensión intracraneal; Diagnóstico diferencialResumen
La cefalea es uno de los síntomas neurológicos más frecuentes en niños y adolescentes, constituyendo un motivo común de consulta médica. Aunque la mayoría de los casos corresponden a cefaleas primarias, como la migraña y la cefalea tensional, una proporción menor puede estar relacionada con causas secundarias potencialmente graves, incluyendo tumores intracraneales, infecciones del sistema nervioso central y aumento de la presión intracraneal. La diferenciación entre cefalea primaria y secundaria representa un desafío fundamental en la práctica clínica pediátrica.
El presente artículo tiene como objetivo proporcionar un enfoque estructurado y basado en la evidencia para la evaluación de la cefalea en la población pediátrica, con énfasis en la identificación de signos de alarma (“red flags”) y en las indicaciones apropiadas para la neuroimagen. Se realizó un análisis de la literatura reciente y de las principales guías clínicas internacionales.
Los signos de alarma, como la presencia de alteraciones neurológicas, vómitos persistentes, patrón progresivo de la cefalea, convulsiones y signos de hipertensión intracraneal, desempeñan un papel central en la identificación de pacientes con mayor riesgo de etiologías secundarias. Sin embargo, su valor diagnóstico no es uniforme, por lo que deben ser interpretados en conjunto con la evaluación clínica global.
La neuroimagen no está indicada de forma rutinaria en niños con cefalea recurrente y examen neurológico normal. La resonancia magnética es el método de elección cuando está indicada, debido a su mayor sensibilidad y a la ausencia de radiación ionizante.
Un enfoque clínico sistemático, que integre una historia clínica detallada, un examen neurológico completo, la adecuada interpretación de los signos de alarma y el uso racional de la neuroimagen, permite optimizar la precisión diagnóstica, garantizar la seguridad del paciente y mejorar la eficiencia en la utilización de los recursos de salud.
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