Clinical warning criteria in evaluation by computed tomography the secondary neurological headaches in adults

Abstract

Our aims were to investigate the frequency of intracranial lesions detected by cranial computed tomography (CT-scan) amongst adult patients who had clinical warning criteria (CWC) for secondary neurological headaches and to determine the importance of CWC in predicting a possible lesion on CT-scan. Seventy consecutive patients with headache exhibiting CWC were included in this prospective study. The CWC included: (i) increase in the intensity and frequency of headache; (ii) abrupt onset of headache; (iii) persistence of headache despite analgesics; (iv) alteration of the characteristics of headache; and (v) presence of focal neurological symptoms or findings. The mean age of the patients was 46.5 years; the female-to-male ratio was 1.5. Of the patients, 35.7% had a neurological cause identified by CT-scan, and 64.3% had normal CT-scan. In the patients without lesion, of headaches, 64.4% were primary, and 35.6% were from undefined headache group. Although, of the above criteria, only the 5th was different markedly in the patients with lesion than the patients without lesion, in evaluation by CT-scan the secondary neurological headaches in adults, all CWC should look for absolutely in their history and physical examination.

Magnetic resonance imaging in chronic headache: our experiences and perspectives

“…[15][16][17][18] These studies have reported a low diagnostic yield in patients with headache presenting for neuroimaging, and reiterated the need to consider red flag signs in selecting patients for neuroimaging. Aygun 15 observed a positive diagnostic yield (35.7%) only in those presenting with focal neurological symptoms or signs and termed this the most important clinical warning criterion (CWC) in deciding who should undergo neuroimaging. In the study done by Nepal 16 the commonest abnormality was sinusitis, with positive brain parenchymal pathologies seen only in 10.1% of the subjects; mainly those with neurological deficits.…”

Should non acute and recurrent headaches have neuroimaging before review by a Neurologist?- A review in a Southern Nigerian Tertiary Hospital

“…[8] Criteria in headaches that are associated with intracranial pathology and serve as red flags for neuroimaging include presence of focal neurological symptoms or findings, abrupt onset, alteration of headache characteristics, increasing intensity and frequency, persistence despite analgesics and headaches that never alternates sides, among others. [9][10][11] The United States headache consortiuma group of acknowledged expert Neurologists and the European Federation of Neurological Societies' (EFNS) Task Force on use of instrumentation in the diagnosis of headaches recommend neuroimaging in ambulatory (non emergency) patients with migraine only in the presence of persistent focal neurological findings or a history of seizures. [12][13][14] While cases of severe acute headaches should expectedly have emergency CT scan to exclude sinister causes like subarachnoid hemorrhage and space occupying lesions, in chronic and recurrent headaches and where the clinical signs are not clearly defined or are difficult to elucidate, the opinion of a Neurologist should advisedly be sought.…”

The Role of Computed Tomography in the Diagnostic Work‐Up of Headache Patients in Nigeria

“…Sobri et al 26 retrospectively analyzed the neuroimaging results of 111 patients whose main indication was headache and found abnormalities in 39 (35.1%). Similarly, Aygun and Bildik 27 analyzed the CT examination in patients with clinical warning criteria and got a high percentage of abnormalities in (35.7%). In this study, the patient with subdural hematoma, aged 58 years, was referred by a neurosurgeon.…”