Diagnostic Yield of Brain Imaging in Headache Patients With Intact Neurological Examination
DOI:
https://doi.org/10.15540/nr.13.2.144Keywords:
Pathological Findings, Uncertain Significance, Red flags, Incidental Findings, Brain imagingAbstract
Background. Many patients presenting with headache complaints are often concerned about the possibility of serious underlying conditions and request brain imaging to rule out ominous pathology. However, brain imaging is costly and carries potential risks for both patients and the healthcare system. Objective. This study aims to evaluate the diagnostic value of brain imaging for patients with headaches and intact neurological examination and to identify additional risk factors associated with abnormal imaging results. Methods. A retrospective cohort analysis was conducted on 185 patients with primary complaints of headache and normal neurological examinations, assessed at a general neurology clinic over a 4-year period. Results. Pathological findings on imaging studies were observed in 9.7% of cases, while 16.2% showed findings of uncertain significance. Patients with pathological or uncertain significance (US) findings are significantly older compared to those with normal results (p = .002 and p < .001, respectively). Male sex is associated with a higher likelihood of US findings
(p = .03). Nonthrobbing headaches and the presence of red flags in patient history are linked to pathological findings (p = .001 and p = .002, respectively). The presumption of a secondary headache syndrome before ordering imaging is strongly associated with abnormal imaging results (p < .001 for pathological findings and
p < .024 for US findings). Conclusion. The decision to perform brain imaging in patients with normal neurological examinations should be individualized based on patient demographics and the presence of nonthrobbing headaches or red flags in the clinical history. A lower threshold for imaging is recommended when secondary headache is suspected.
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