Appropriate Use of Neuroimaging in Headache

Kuruvilla, Deena; Lipton, Richard B.

doi:10.1007/s11916-015-0490-3

Cited by 17 publications

(12 citation statements)

References 44 publications

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“…On the one hand, patients with headache are anxious about the possibility that they have a brain tumor or aneurysm. 7,15,17 In China, the tense relationships and lower levels of trust between physicians and patients were another important cause. The scanned patients were worried about being diagnosed with a serious cause for their headache at 1 year.…”

Section: Discussionmentioning

confidence: 99%

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Unnecessary Neuroimaging for Patients With Primary Headaches

et al. 2018

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Background - Headache may be due to either a primary or secondary disorder, and neuroimaging assessments can play an important role when differentiating between these types of headache. Although many studies have reported no significant differences between primary headache patients and the general population in terms of abnormal neuroimaging findings, others have shown that neuroimaging may be employed to rule out secondary causes of headache that could impact morbidity and mortality. This issue remains under debate. Thus, the present study compared the neuroimaging findings of headache patients and healthy controls. Methods - This study recruited 1070 healthy controls and 1070 primary headache patients from the Chinese People's Liberation Army General Hospital. The primary headache patients were diagnosed by computerized clinical decision support systems, and re-diagnosed by a specialist. All participants were assessed with either computed tomography or magnetic resonance imaging (MRI) scans. The neuroimaging findings were classified as significant abnormalities, non-significant abnormalities, or normal. Results - All the significant abnormalities were found using MRI scans. Significant abnormalities were identified in 4 primary headache patients (0.58%) and 5 healthy controls (0.73%); the rate of significant abnormalities was not significant different between both groups (P > .05). Conclusions - The present study found that neuroimaging was unnecessary for the primary headache patients.

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Section: Discussionmentioning

confidence: 99%

“…Moreover, neuroimaging might reassure patients and improve their quality of life. 7,15,17 In China, the tense relationships and lower levels of trust between physicians and patients were another important cause. 18,19 Finally, we would like to restate the limitations of the present findings.…”

Section: Discussionmentioning

confidence: 99%

Unnecessary Neuroimaging for Patients With Primary Headaches

et al. 2018

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“…Finally, the cost-effectiveness of neuroimaging in headache patients needs to be determined. Until now, neuroimaging has been considered unnecessary for primary headache patients, especially those with chronic headache and no focal neurological signs [5,6,37]. As such, cost effectiveness should be evaluated according to headache type, symptoms and signs, and the implemented neuroimaging tool.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Neuroimaging in Headache Patients: A Systematic Review and Meta-Analysis

Jang

Cho

Choi

et al. 2019

Psychiatry Investig

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Objective Neuroimaging in headache patients identifies clinically significant neurological abnormalities and plays an important role in excluding secondary headache diagnoses. We performed a systematic review and meta-analysis of the existing guidelines and studies surrounding neuroimaging in headache patients. Methods The research question involved determining the prevalence of detecting clinically significant neurological abnormalities using neuroimaging in patients suspected of primary headache. Searches of the PubMed and Embase databases were conducted on English-language studies published from 1991 to 2016, and the reference lists of the retrieved articles were also checked manually. All headache subtypes and patients aged ≥15 years were included in the analysis. Results Ten studies met the selection criteria. The pooled prevalence of detecting clinically significant abnormalities in the neuroimaging of headache patients was 8.86% (95% confidence interval: 5.12–15.33%). Subsequently, diverse subgroup analyses were performed based on the detection method, headache type, study type, study region, age group, and disease type. Conclusion The present findings indicate that limited neuroimaging methods should be carefully considered for headache diagnostic purposes when there are red flag symptoms. Limitations and suggested directions for future studies on neuroimaging in headache patients are described.

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“…Neuroimaging techniques have shown to represent a valuable diagnostic bridge between neurophysiological studies and clinical findings [18]. At the same time, it is important to consider the low yield of imaging procedures for individuals presenting with headache unaccompanied by other neurological findings [19][20][21][22][23][24].…”

Section: Introduction/backgroundmentioning

confidence: 99%

ACR Appropriateness Criteria® Headache

Whitehead

Cardenas

Corey

et al. 2019

Journal of the American College of Radiology

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Headache is one of the most common human afflictions. In most cases, headaches are benign and idiopathic, and resolve spontaneously or with minor therapeutic measures. Imaging is not required for many types of headaches. However, patients presenting with headaches in the setting of "red flags" such as head trauma, cancer, immunocompromised state, pregnancy, patients 50 years or older, related to activity or position, or with a corresponding neurological deficit, may benefit from CT, MRI, or noninvasive vascular imaging to identify a treatable cause. This publication addresses the initial imaging strategies for headaches associated with the following features: severe and sudden onset, optic disc edema, "red flags," migraine or tension-type, trigeminal autonomic origin, and chronic headaches with and without new or progressive features.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

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Appropriate Use of Neuroimaging in Headache

Cited by 17 publications

References 44 publications

Unnecessary Neuroimaging for Patients With Primary Headaches

Unnecessary Neuroimaging for Patients With Primary Headaches

Diagnostic Neuroimaging in Headache Patients: A Systematic Review and Meta-Analysis

ACR Appropriateness Criteria® Headache

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