Which of the following headaches in a child is a red flag warranting neuroimaging?

• A. New neuro deficits
• B. Headache relief with sleep
• C. No symptoms
• D. Headache that occurs only during the school day

Answer: (A)

A new neurological deficit in a child with headache is a major warning sign for possible structural brain disease, so imaging is needed to look for something like a tumor, hemorrhage, or hydrocephalus. When a child suddenly develops new weakness, numbness, trouble speaking, vision changes, or coordination problems, it suggests the brain itself may be affected, making neuroimaging the appropriate next step.

Headache that gets better with sleep or occurs only in a specific setting (like during the school day) without any new or focal neurological signs fits more with benign primary headaches such as migraines or tension-type headaches, where imaging isn’t routinely required. If other red flags appear—such as morning vomiting, papilledema on exam, or a rapidly worsening course—that would also steer toward imaging, but the defining red flag in this scenario is the new neuro deficit.