Journal of Neurology

, Volume 257, Issue 8, pp 1274–1278 | Cite as

Imaging results in a consecutive series of 530 new patients in the Birmingham Headache Service

  • C. E. Clarke
  • J. Edwards
  • D. J. Nicholl
  • A. Sivaguru
Original Communication


Guidelines recommend imaging only headache patients with sinister features in the history or on examination. We prospectively collected data on imaging newly presenting patients to a UK headache service. CT and MRI results were classified as normal or showing an insignificant or significant abnormality. Over 5 years, 3,655 new patients (69% female; mean age 42.0 years) with headache disorders were seen. Five hundred thirty (14.5%) underwent imaging with large differences in the proportion referred by each consultant. There were more insignificant abnormalities on MRI (46%) than CT (28%). There were 11 significantly abnormal results (2.1% of those imaged). Significant abnormalities were found in patients diagnosed with migraine in 1.2% and in 0.9% of those with tension-type headache. Significant abnormalities in those suspected to have an intracranial abnormality occurred in 5.5%. This supports the practice of selecting patients with suspicious findings for imaging, rather than imaging all patients.


Headache Migraine Tension-type headache Imaging Guidelines 



We thank all of our colleagues in the imaging departments involved in this study, along with the patients suffering from headache disorders.

Conflicts of interest statement

None to disclose.


  1. 1.
    Kernick DP, Ahmed F, Bahra A, Dowson A, Elrington G, Fontebasso M et al (2008) Imaging patients with suspected brain tumour: guidance for primary care. Br J Gen Pract 58(557):880–885CrossRefPubMedGoogle Scholar
  2. 2.
    National Institute for Health and Clinical Excellence (2005) Referral guidelines for suspected cancer.
  3. 3.
    American Academy of Neurology (2008) Report of the Quality Standards Sub-Committee of the American Academy of Neurology. The utility of neuro imaging in the evaluation of headache in patients with normal neurological examinations.
  4. 4.
    Sempere AP, Porta-Etessam J, Medrano V, Garcia-Morales I, Concepcion L, Ramos A et al (2005) Neuroimaging in the evaluation of patients with non-acute headache. Cephalalgia 25(1):30–35CrossRefPubMedGoogle Scholar
  5. 5.
    Morris Z, Whiteley WN, Longstreth WT Jr, Weber F, Lee YC, Tsushima Y et al (2009) Incidental findings on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ 339:b3016CrossRefPubMedGoogle Scholar
  6. 6.
    Howard L, Wessely S, Leese M, Page L, McCrone P, Husain K et al (2005) Are investigations anxiolytic or anxiogenic? A randomised controlled trial of neuroimaging to provide reassurance in chronic daily headache. J Neurol Neurosurg Psychiatry 76(11):1558–1564CrossRefPubMedGoogle Scholar
  7. 7.
    Clarke CE, Edwards J, Nicholl DJ, Sivaguru A, Davies P, Wiskin C (2005) Ability of a nurse specialist to diagnose simple headache disorders compared with consultant neurologists. J Neurol Neurosurg Psychiatry 76(8):1170–1172CrossRefPubMedGoogle Scholar
  8. 8.
    Clarke CE, Edwards J, Nicholl DJ, Sivaguru A (2008) Prospective evaluation of a nurse-led headache service in a sub-regional neurology unit. Br J Neurosci Nurs 4(2):2–6Google Scholar
  9. 9.
    International Headache Society (2004) The International Classification of Headache Disorders. Cephalagia 24 (suppl 1)Google Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • C. E. Clarke
    • 1
    • 2
  • J. Edwards
    • 2
  • D. J. Nicholl
    • 1
    • 2
  • A. Sivaguru
    • 2
  1. 1.School of Clinical and Experimental Medicine, College of Medicine and Dental SciencesUniversity of BirminghamBirminghamUK
  2. 2.Department of Neurology, City HospitalSandwell and West Birmingham Hospitals NHS TrustBirminghamUK

Personalised recommendations