Aim To improve awareness of the criteria for neuroimaging in children with recurrent headaches in a district general hospital. Method This was a retrospective quality improvement study, with a total of 26 case notes reviewed. The inclusion criterion was children under 17 years of age with recurrent headache as their primary presenting complaint. These were taken from either presentation to the acute assessment unit or outpatient clinics (neurology and non-specialist clinics). Documentation of red-flag signs and symptoms used were derived from BPNA, NICE and Headsmart guidelines. Criteria for neuroimaging was defined as met if any of the patients had one or more red-flag signs or symptoms present.

Results 88% of the cases were taken from outpatient clinics and the mean age was 12 years (6–16 years). The average rate of documentation of red-flag signs and symptoms was 78%. 58% (15/26) of all patients met the criteria for neuroimaging. Of these 15 patients, 13 (86%) were sent for neuroimaging and 2 (14%) were not. In the group sent for neuroimaging, all scans did not show any abnormalities, apart from one patient who was found to have a brain tumour. There were 2 cases that met the criteria for imaging but did not receive it. One patient had a recent onset severe headache, and the other had early morning waking with a headache. Out of the remaining 11 (42%) patients who did not meet the criteria for neuroimaging, 2 patients were sent for neuroimaging. No abnormality was detected in either of the cases.

Conclusion Increased awareness of the criteria for neuroimaging in children with recurrent headaches is paramount, as this will minimise unnecessary use of neuroimaging in children, ensuring that those who are at a higher risk are investigated. Thus, we have introduced the use of a chronic headache proforma for the department, including an aide memoire of the criteria for neuroimaging. A limitation of the study is its small sample size and this will be overcome with a further audit on a larger patient group in 6 months.