Significant and nonsignificant findings on magnetic resonance imaging of patients with headache

Year 2022, , 670 - 675, 15.03.2022

Hatice Yüksel , Görkem Tutal Gürsoy , Hesna Bektaş

https://doi.org/10.32322/jhsm.1070220

Abstract

Aim: The great majority of people suffer from headaches. Neuroimaging has a very limited role in determining the etiology of headache However, neuroimaging, especially magnetic resonance imaging (MRI), is requested for the vast majority of patients with headache. We aimed to determine the frequency of clinically significant and nonsignificant findings on brain MRI in patients with headache, and the factors associated with these findings.
Material and Method: A total of 350 patients (231 women and 119 men), who underwent MRI examinations for headache complaints, were included in the study. Based on the evaluation of lesions detected on MRI and headache characteristics together, lesions associated with headache were classified as significant findings, and lesions unrelated to headache were classified as nonsignificant findings. Patients were compared in terms of brain MRI findings on the basis of age, gender, and duration of headache complaints.
Results: Assessment of brain MRIs revealed normal findings in 211 (60.3%) patients, nonsignificant findings in 122 (34.8%) patients, and significant findings that could cause headache in 17 (4.9%) patients. The most common significant lesions were acute sinusitis, acute cerebrovascular accident, cerebral venous sinus thrombosis and aneurysm. In patients over 65 years of age, the frequency of significant findings was significantly higher (p:0.001). The frequency of significant findings was higher in male patients and patients with a headache duration of less than one month, but there was no statistical difference (p:0.452 and p:0477).
Conclusion: We found significant findings on brain MRI in approximately 5% of patients with headache. Being over 65 years old and acute onset headache increase the probability of detecting significant lesions on MRI. Despite its low diagnostic value, physicians will often refer patients with headaches to neuroimaging for fear of missing a critical underlying lesion and encountering medico-legal issues. Taking into account worrying red flags can increase the likelihood of finding significant lesions.

Keywords

Headache, Neuroimaging, Magnetic resonance imaging

References

• Robbins MS. Diagnosis and management of headache: a review. JAMA. 2021; 325: 1874-85.
• Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018; 38: 1-211.
• Rizzoli P, Mullally WJ. Headache. Am J Med 2018; 131 :17-24.
• Evans RW. Incidental findings and normal anatomical variants on MRI of the brain in adults for primary headaches. Headache 2017; 57 :780-91.
• Kenteu B, Fogang YF, Nyaga UF, Zafack JG, Noubiap JJ, Kamtchum-Tatuene J. Neuroimaging of headaches in patients with normal neurological examination: protocol for a systematic review. BMJ Open 2018; 8: e020190.
• Bafaraj SM. Evaluation of neurological disorder using computed tomography and magnetic resonance imaging. JBM 2021; 09: 42-51.
• Micieli A, Kingston W. An approach to identifying headache patients that require neuroimaging. Front Public Health 2019; 7: 52.
• Sempere A, Porta-Etessam J, Medrano V, et al. Neuroimaging in the evaluation of patients with non-acute headache. Cephalalgia 2005; 25: 30-5.
• Flores-Montanez Y, Nahas SJ. Unusual brain MRI findings in patients imaged for headache: a case series. Curr Pain Headache Rep 2020; 24 :51.
• Morris Z, Whiteley WN, Longstreth WT, et al. Incidental findings on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ 2009; 339: b3016-b3016.
• Do TP, la Cour Karottki NF, Ashina M. Updates in the diagnostic approach of headache. Curr Pain Headache Rep 2021; 25: 80.
• Budweg J, Sprenger T, De V-T, Hagenkord A, Stippich C, Berger C. Factors associated with significant MRI findings in medical walk-in patients with acute headache. Swiss Med Wkly 2016; 146: w14349.
• Goadsby PJ. To scan or not to scan in headache. BMJ 2004; 329: 469-70.
• Clarke CE, Edwards J, Nicholl DJ, Sivaguru A. Imaging results in a consecutive series of 530 new patients in the Birmingham Headache Service. J Neurol 2010; 257: 1274-8.
• Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM. Does this patient with headache have a migraine or need neuroimaging? JAMA 2006; 296 :1274-83.
• Johnston JC, Wester K, Sartwelle TP. Neurological Fallacies Leading to Malpractice. Neurol Clin 2016; 34: 747-73.
• Nahed BV, Babu MA, Smith TR, Heary RF. Malpractice liability and defensive medicine: a national survey of neurosurgeons. PLoS One 2012; 7: e39237.
• Caponnetto V, Deodato M, Robotti M, et al. Comorbidities of primary headache disorders: a literature review with meta-analysis. J Headache Pain 2021; 22: 71.
• Akyildiz K, Sercan M, Yildiz N, Cevik A, Kiyan A. Is headache only headache? comorbidity of headaches and mental disorders. DAJPNS 2015; 2828: 34-46.
• Smitherman TA, Baskin SM. Headache secondary to psychiatric disorders. Current Science Inc 2008; 12: 305-310.