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Common diagnoses and factors associated with abnormal neuroimaging in headache patients in the emergency department
Mohammed H Alanazy1, Hassan Almalak1, Malak Alaboudi1
1Department of Internal Medicine (Alanazy, Almalak, Alaboudi, Albilali, Muayqil), College of Medicine, King Saud University, from the Department of Radiology and Medical Imaging (Abujamea), King Saud University Medical City & College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
Insights
Secondary headache disorders are common in emergency department patients undergoing neuroimaging. Neurological signs and recent headache onset increase the likelihood of abnormal findings.
Area of Science:
- Neurology
- Emergency Medicine
- Radiology
Background:
- Headaches are a frequent reason for emergency department visits.
- Neuroimaging is often employed to diagnose the cause of severe or persistent headaches.
Purpose of the Study:
- To identify the causes of headaches in patients requiring neuroimaging in the emergency department.
- To determine clinical features predicting abnormal neuroimaging results in these patients.
Main Methods:
- Retrospective analysis of 329 patients who underwent neuroimaging for headache between June 2015 and May 2019.
- Assessment of associations between clinical characteristics and neuroimaging findings.
Main Results:
- Abnormal neuroimaging was found in 31.9% of patients.
- Secondary headache disorders were the most common diagnosis (48.9%).
- Headache onset within one month and abnormal neurological signs were significantly associated with abnormal neuroimaging.
Conclusions:
- Secondary headaches are prevalent in emergency department patients undergoing neuroimaging.
- The presence of neurological signs and recent headache onset are key indicators for abnormal neuroimaging findings.
Objectives:
To determine causes of headaches in patients who presented to the emergency department (ED) and underwent neuroimaging, and to determine the clinical features associated with abnormal neuroimaging.
Methods:
Patients were retrospectively selected from a database between June, 2015 and May, 2019. Patients were included if they had neuroimaging requested from the ED mainly for headache. Associations between clinical characteristics and abnormal neuroimaging were assessed.
Results:
We included 329 patients (33.4% men, 66.6% women). The mean (SD) age was 39.7 (18.4) years. Neurological signs were reported in 43.8% of the patients, head-computed tomography was requested in 79.6%, magnetic resonance imaging in 77.5%, and both in 57.1%. Abnormal neuroimaging was reported in 31.9%. The most common reported diagnoses were secondary headache disorders (48.9%), followed by primary headache disorders (16.4%). The remainder were nonspecific-headaches (35%). Variables associated with abnormal neuroimaging were headache onset ≤1 month (OR 3.37, CI 1.47-7.70, p=0.004), and presence of an abnormal neurological sign (OR 3.60, CI 1.89-6.83, p<0.001).
Conclusion:
Secondary headache disorders are common in patients who undergo neuroimaging in the ED. Those who have a neurological sign and recent onset of headache are more likely to have abnormal neuroimaging.
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