Brain MR Imaging in the Evaluation of Chronic Headache in Patients without Other Neurologic Symptoms
Section snippets
Materials and Methods
We reviewed the clinical data and imaging studies of adult patients referred for MR imaging evaluation of headache over a 2-year period. Inclusion criteria were as follows: (a) primary complaint of headache with a duration of 3 months or more, (b) no other neurologic symptoms or findings, and (c) evaluation by the neurology service. Of 444 patients whose cases were reviewed, 402 met these criteria, including 286 women and 116 men (aged 18–85 years).
Sagittal T1-weighted, axial proton
Results
The most common headache types encountered were migraine, tension headaches, mixed migraine and tension headaches, and atypical headaches. Patients with atypical headaches have features that are not readily classified. Among other headache types encountered were cluster headaches, posttraumatic headaches, and those related to sinusitis. The distribution of ages and headache types is given in Table 1. Women outnumbered men in all age groups and headache categories; the overall ratio was 2.4:1.
Discussion
A recent article (10) reviewed the literature on neuroimaging of patients with headache and normal neurologic examinations. This meta-analysis included a survey of 17 studies with 18 or more patients, for a total of 1,825 CT and MR imaging studies, 897 in patients with migraine. The total yield of pathologic abnormality was 2.4%. On the basis of these data, the author and the Quality Standards Subcommittee of the American Academy of Neurology stated the following: “In adult patients with
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2019, Neurologic ClinicsCitation Excerpt :Pituitary pathologic condition is more likely to be detected on a routine MRI than CT scan. Wang and coworkers29 retrospectively reviewed the medical records and MRI images of 402 adult patients (286 women and 116 men) who had been evaluated by the neurology service and who had a primary complaint of chronic headache (a duration of 3 months or more) and no other neurologic symptoms or findings. Major abnormalities (a mass, caused mass effect, or was thought the likely cause of patient’s headache) were found in 15 patients (3.7%) and included glioma, meningioma, metastases, subdural hematoma, AVM, hydrocephalus (3 patients), and Chiari I malformations (2 patients).
Headache and Brain Tumor
2019, Neuroimaging Clinics of North AmericaCitation Excerpt :The term atypical headache can be applied to those that are similar to primary headaches but have atypical features or clinical course. Although there are no definitive prevalence estimates of atypical headaches, one study found that major MR imaging abnormalities were found in 14.1% of atypical headache cases, while they were found in only 1.4% of tension-type and 0.6% of migraine headaches.7 As opposed to primary headaches, the term secondary headaches refers to those with underlying pathologies such as intracranial tumor, infection, ruptured aneurysm, or giant cell arteritis.
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W.R.G. supported in part by National Cancer Institute grant CA16056.