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Adults and children with headache: evidence-based diagnostic evaluation
L Santiago Medina1, Belinda D'Souza, Elza Vasconcellos
1Health Outcomes, Policy, and Economics (HOPE) Center, Department of Radiology, Miami Children's Hospital, 3100 SW 62nd Avenue, Miami, FL 33155, USA. smedina@post.harvard.edu
Neuroimaging Clinics of North America
|September 19, 2003
Summary
Headache diagnosis relies on clinical evaluation, but neuroimaging like CT and MR, along with lumbar puncture, are crucial for detecting serious conditions such as subarachnoid hemorrhage (SAH) and brain tumors.
Area of Science:
- Neurology
- Radiology
- Diagnostic Imaging
Background:
- Headaches are a frequent reason for medical consultations, with most cases being benign.
- Establishing definitive indications for neuroimaging in headache evaluation is challenging due to limited high-level evidence.
- Existing guidelines for neuroimaging in headache are based on level 2 and 3 evidence.
Purpose of the Study:
- To review current diagnostic strategies for headache evaluation.
- To outline the roles of various imaging modalities and lumbar puncture in diagnosing serious intracranial pathologies.
- To discuss the evolving utility of diagnostic tools in headache assessment.
Main Methods:
- Review of existing literature on diagnostic tests for headache.
- Analysis of evidence supporting neuroimaging (CT, MR imaging) and lumbar puncture.
- Evaluation of diagnostic test choices based on patient risk stratification (adults vs. children, high-risk vs. low-risk).
Main Results:
- CT is the preferred initial imaging for new-onset headaches in adults and suspected subarachnoid hemorrhage (SAH).
- Lumbar puncture is recommended when CT is equivocal for SAH.
- Contrast-enhanced MR imaging is the gold standard for suspected brain metastases, especially lesions <2 cm.
Conclusions:
- Clinical diagnosis is paramount in headache evaluation.
- CT, MR imaging, and lumbar puncture are vital for identifying critical intracranial conditions like SAH and space-occupying lesions.
- The role of these diagnostic tools will continue to advance with technological improvements and increased clinical expertise.