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capacity, limited availability continues to be the main drawback of MRI Even when the MRI is available, children may require deep sedation under the supervision of an anesthesiologist This makes nonemergent MRI scans difficult to obtain from the ED, even in large institutions As discussed in the following, the emergency physician must take these and other factors into account in determining which, if any, imaging modality is indicated for a child with headaches Treatment and Disposition Patients with headaches caused by a potentially life-threatening process (e.g., meningitis, encephalitis, ruptured vascular anomaly) require specific treatment approaches discussed elsewhere in this textbook A patient with idiopathic intracranial hypertension may require drainage of CSF to reduce the ICP, which, in turn, often relieves the headache Children with headaches that are presumptively diagnosed as benign can often be successfully treated with acetaminophen or ibuprofen It is important to treat and not underestimate the pain the child may be experiencing Nerve blocks are also being studied as a potential treatment option for primary headaches The various options available for treating pediatric migraine patients are described in Chapter 97 Neurologic Emergencies Although most children complaining of headache can be safely discharged from the ED with an appropriate follow-up plan, some will require admission to the hospital for further evaluation and treatment For example, a child with headaches who is found to be significantly hypertensive must be admitted both for management of the blood pressure and investigation of the underlying cause Any patient with idiopathic intracranial hypertension who also has decreased visual acuity requires emergent evaluation by an ophthalmologist and possibly a surgical procedure to relieve the pressure on the optic nerve Patients with migraine who have intractable headache may also warrant admission for more effective analgesia The child with a ventricular shunt who has severe headaches will usually require a shunt series, a CT scan of the head, and neurosurgical evaluation to assess the need for possible shunt revision If neurosurgical consultation is not immediately available, the patient should be transported to an appropriate receiving facility A potentially confusing issue that the emergency physician will inevitably face is how to properly manage a child who is suspected of having a brain tumor Should all these patients have a brain imaging study in the ED? As discussed previously, the resolution of even a contrast-enhanced head CT scan is inferior to MRI for detecting certain types of tumors Also, a small but finite risk is