Elsevier

Academic Radiology

Volume 8, Issue 5, May 2001, Pages 405-408
Academic Radiology

Brain MR Imaging in the Evaluation of Chronic Headache in Patients without Other Neurologic Symptoms

https://doi.org/10.1016/S1076-6332(03)80548-2Get rights and content

Abstract

Rationale and Objectives

The authors investigated the use of magnetic resonance (MR) imaging of the brain in adult patients with a primary complaint of chronic headache and no other neurologic symptoms or findings and determined the yield and MR predictors of major abnormalities in these patients.

Materials and Methods

The medical records and MR images of 402 adult patients with chronic headache were retrospectively reviewed. All patients had been evaluated and referred by the neurology service. The findings were categorized as either negative or positive for major abnormality. Multivariate analysis with a linear logistic regression technique was performed on the clinical data, which included patient age, patient sex, and headache type.

Results

Major abnormalities were found in 15 patients (3.7%), consisting of seven women (2.4%) and eight men (6.9%). Major abnormalities were found in 0.6% of those with migraine headaches, 1.4% with tension headaches, none with mixed migraine and tension headaches, 14.1% with atypical headaches, and 3.8% with other types of headaches. Multivariate analysis showed that the atypical headache type was the most significant predictor of major abnormality.

Conclusion

The yield of major abnormalities found with brain MR imaging in patients with isolated chronic headache is low. However, those patients with atypical headaches have a higher yield of major abnormalities and may benefit from imaging.

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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W.R.G. supported in part by National Cancer Institute grant CA16056.

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