Computerised tomography neuroimaging use and yield in non-traumatic headache: A retrospective study in a tertiary...

Headache is a common emergency department (ED) presentation. We aimed to determine the proportion of patients undergoing Computerised Tomography (CT) for non-traumatic headache and identify factors influencing clinician decision-making.

We conducted a retrospective chart review of adult ED presentations at the Royal Melbourne Hospital from January to March 2024. Clinical features and CT data were extracted and mapped against SNOOP4 features.

Among 223 patients, 124 (55.6 %) underwent CT, with abnormal findings in 15.3 % (19/124). No patient-reported symptoms increased the likelihood of CT ordering; photophobia was negatively associated (Odds Ratio (OR)= 0.41, 95 % Confidence Interval (CI):0.22-0.79). Examination abnormalities in peripheral sensation (OR=13.04, 95 %CI:1.69-100.59) and strength (OR= 3.62, 95 %CI:1.00-13.09) increased CT use. Patients with > 2 SNOOP4 features had markedly higher odds of receiving CT (OR= 13.5, 95 %CI:3.12-58.34) and of abnormal findings (OR= 5.75, 95 %CI:2.03-16.27).

CT neuroimaging for non-traumatic headache was frequently performed, with a relatively low abnormal yield. While patient-reported symptoms did not influence CT ordering, examination findings and cumulative SNOOP4 features were associated with both imaging decisions and abnormal results. These findings support future studies into red-flag-based pathways to guide purposeful CT use.