Diagnostic evaluation of headache. Impact of computerized tomography and cost-effectiveness

One hundred sixty-one highly selected patients with headache were studied to assess the impact of computerized tomography (CT) on diagnostic evaluation and to determine cost-effectiveness of neurodiagnostic evaluation of headache. Fewer nuclide brain scans were performed after availability of CT, but diagnostic charges stayed about the same. A careful history and physical and neurological examinations were adequate screens to detect intracranial mass lesions or systemic disease associated with headache. In patients with normal findings from neurological examination, no clinically important abnormalities were detected by CT, skull roentgenogram, angiography, or nuclide brain scan. The cost of finding a case of brain tumor was estimated to be at least $1,265 for patients with abnormalities on neurological examination and $11,901 for patients with normal findings on neurological examination. Neurodiagnostic evaluation of headache patients with normal findings from neurological examination is expensive and was clinically unrewarding in this series.