Le red flag della cefalea pediatrica

The paper reports the case of a 4-year-old child presenting to the Emergency Room with a two-week history of morning headache and recurrent vomiting. Despite overall good clinical condition, examination revealed mild gait instability and papilledema. The application of the SNNOOP10 score identified four key red flags, justifying an urgent CT scan that revealed obstructive triventricular hydrocephalus secondary to a fourth ventricle lesion, later diagnosed as an ependymoma and surgically removed. While highlighting the importance of red flags in paediatric headaches, this case underscores the limitations of SNNOOP10 in children. Because the tool is not validated for the paediatric population, indiscriminate use risks overutilisation of CT scans and unnecessary radiation exposure. Therefore, paediatric-specific decision-making tools are needed and a thorough clinical and neurological evaluation remains paramount.