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Computed tomography in the headache patient: is routine evaluation really necessary?
C S Mitchell1, R E Osborn, S R Grosskreutz
1Department of Radiology, Naval Hospital, San Diego, California.
Headache
|February 1, 1993
Summary
Routine brain computed tomography (CT) for headaches rarely reveals significant disease in patients with normal exams. This imaging has a low likelihood ratio for detecting serious intracranial conditions in this population.
Area of Science:
- Neurology
- Radiology
- Diagnostic Imaging
Background:
- Headache is a common presenting complaint in clinical practice.
- Computed tomography (CT) of the brain is frequently utilized in the evaluation of headache patients.
- The diagnostic yield of routine brain CT in uncomplicated headaches is debated.
Observation:
- A prospective study evaluated 350 patients presenting with headache.
- Patients with complicating factors like trauma or known neoplasm were excluded.
- Brain CT scans were performed as part of the routine evaluation.
Findings:
- Only 2% of patients had clinically significant CT findings.
- An additional 7% had clinically insignificant positive CT findings.
- All significant findings were associated with abnormal physical/neurologic exams or unusual symptoms.
Implications:
- Routine brain CT is unlikely to detect significant intracranial pathology in headache patients with normal examinations.
- The low yield suggests CT should be reserved for cases with concerning clinical features.
- This supports a more selective approach to neuroimaging for headache evaluation.