Paediatric migraine red flags — SCE Neurology MCQ

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HardSpecial GroupsPaediatric migraine red flagsSCE Neurology

A 13-year-old has progressive early-morning vomiting, headache waking him from sleep, horizontal diplopia, papilloedema and a sixth-nerve palsy. He is haemodynamically stable and has no meningism. What is the most appropriate next investigation?

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Correct answer: A — Urgent contrast-enhanced brain MRI

The best answer is “Urgent contrast-enhanced brain MRI”. Papilloedema, a false-localising sixth-nerve palsy and progressive morning symptoms indicate raised intracranial pressure; urgent structural imaging is required before considering lumbar puncture. “Treat as migraine without neuroimaging” is less appropriate because migraine history cannot override objective intracranial-pressure signs “Arrange routine optician review in six months” is less appropriate because delayed community review risks visual loss and neurological deterioration “Perform lumbar puncture before excluding a mass lesion” is less appropriate because CSF removal before imaging can be dangerous if a space-occupying lesion obstructs pressure pathways “Reassure because a parent has migraine” is less appropriate because family history does not explain papilloedema

Reference: NICE NG127: Suspected neurological conditions — recommendations. https://www.nice.org.uk/guidance/ng127/chapter/Recommendations