Abstract
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
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):880–885
National Institute for Health and Clinical Excellence (2005) Referral guidelines for suspected cancer. http://www.nice.org.uk/nicemedia/pdf/cg027niceguideline.pdf
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. http://www.aan.com/professionals/practice/pdfs/gl0088.pdf
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):30–35
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:b3016
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):1558–1564
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):1170–1172
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):2–6
International Headache Society (2004) The International Classification of Headache Disorders. Cephalagia 24 (suppl 1)
Acknowledgments
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Clarke, C.E., Edwards, J., Nicholl, D.J. et al. Imaging results in a consecutive series of 530 new patients in the Birmingham Headache Service. J Neurol 257, 1274–1278 (2010). https://doi.org/10.1007/s00415-010-5506-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-010-5506-7