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Neurophysiological tests and neuroimaging procedures in non-acute headache (2nd edition)
G Sandrini1, L Friberg, G Coppola
1University Centre for Adaptive Disorders and Headache (UCADH), IRCCS C. Mondino Foundation, Pavia, Italy. giorgio.sandrini@mondino.it
European Journal of Neurology
|September 28, 2010
Summary
Most instrumental investigations offer limited clinical value for non-acute headache diagnosis. While some tools aid research, routine use is often unwarranted, though potential exists for differential diagnosis and pathophysiology studies.
Area of Science:
- Neurology
- Neuroscience
Background:
- Numerous instrumental investigations are employed for non-acute headache in research and clinical settings.
- While valuable for understanding headache pathogenesis, many tools lack clinical utility.
Purpose of the Study:
- To provide updated guidelines on neurophysiological tools and neuroimaging for non-acute headache.
- To reassess the evidence and recommendations from the 2004 EFNS guidelines.
Main Methods:
- Review and update of existing guidelines based on published literature.
- Evaluation of neurophysiological tools (EEG, evoked potentials, reflex responses, autonomic tests, muscle palpation, EMG) and neuroimaging (MRI, PET, SPECT, Doppler).
Main Results:
- Routine interictal EEG is not indicated unless epilepsy is suspected. Evoked potentials, reflex responses, and autonomic tests lack diagnostic value.
- Manual palpation can aid patient subgrouping but not diagnosis. Routine neuroimaging is not warranted for typical migraine. Specific indications exist for neuroimaging in trigeminal autonomic cephalalgia and atypical headaches.
- PET/SPECT scans are generally not useful if attacks fit standard classification. Transcranial Doppler is unhelpful for headache diagnosis.
Conclusions:
- Many instrumental examinations have limited clinical value for non-acute headache diagnosis.
- Tools like thermal pain thresholds and transcranial magnetic stimulation show potential for differential diagnosis and research into headache pathophysiology and treatment effects.
