Researchers at Children’s Hospital of Philadelphia and Children’s Hospital of Michigan, Detroit, determined the frequency of acute care visits for headache in children with homozygous sickle cell disease (SCD-SS), neuroimaging studies, and associated CNS events. Of 2685 acute care visits by children with SCD-SS, 102 (3.8%) presented with headache as the chief complaint, and acute CNS events were diagnosed at 6.9% of these visits. Neuroimaging, performed in 42.2% of visits, identified acute CNS events in 16.3% of studies. Risk factors for acute CNS events that warrant confirmatory neuroimaging include older age, history of stroke, transient ischemic attack, or seizure, neurologic symptoms, focal neurologic exam, and elevated platelets. 
COMMENT. The authors recommend neuroimaging in children with SCD-SS who present with acute headache and have associated neurologic symptoms, focal findings on exam and /or a history of stroke, transient ischemic attack, or seizure, or elevated platelet count. Consider imaging in patients with atypical headache, abnormal transcranial Doppler, vasculopathy on MRA, and/or silent infarcts.