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Computed tomography evaluation of patients with chronic headache
M D Dumas1, J H Pexman, J H Kreeft
1Department of Radiology, University of Western Ontario, London.
Summary
Computed tomography (CT) scans for chronic headache patients rarely detect significant intracranial lesions like tumors or aneurysms. The high cost of CT imaging for these infrequent findings makes it an inefficient diagnostic approach.
Area of Science:
- Neurology
- Radiology
- Health Economics
Background:
- Chronic headache is a common condition with various potential underlying causes.
- Diagnostic imaging, including computed tomography (CT), is often considered for patients with chronic headaches, particularly those with concerning symptoms or risk factors.
- The utility and cost-effectiveness of CT in identifying significant intracranial pathologies in this patient group require evaluation.
Purpose of the Study:
- To assess the diagnostic yield of enhanced and unenhanced CT scans in detecting tumors, arteriovenous malformations (AVMs), or aneurysms in patients presenting with chronic headache.
- To determine the cost-effectiveness of utilizing CT scanning for the diagnosis of intracranial structural lesions in patients with chronic headache.
Main Methods:
- A case series design was employed, analyzing data from 373 consecutive patients with chronic headache referred for CT scanning.
- Patients met specific criteria, including increased symptom severity, resistance to therapy, change in headache pattern, or family history of intracranial lesions.
- CT scans were performed using enhanced (with contrast medium) or unenhanced techniques, or a combination of both.
Main Results:
- Out of 402 CT scans, 14 revealed minor findings not altering management, while only 4 showed significant lesions (osteoma, glioma, aneurysm).
- No arteriovenous malformations (AVMs) were detected.
- The cost per significant finding exceeded $18,000, with a total cost of $74,243 to identify one treatable vascular lesion (aneurysm).
Conclusions:
- The detection rate of intracranial lesions via CT in chronic headache patients with normal neurological findings is comparable to the general population.
- CT scanning for chronic headache patients yields a low rate of significant findings, making it a costly diagnostic strategy.
- The high cost associated with detecting rare intracranial lesions in this population suggests a need for careful consideration of CT utilization.