Computed tomography scan of the head in patients with migraine or tension-type headache

Abstract

-A retrospective study was performed in order to evaluate the frequency of abnormalities found by computed tomography (CT) scan of the head in 78 patients with migraine or tension-type headache. In the present study CT scan was normal in 61.5% of the patients with migraine or tension-type headache. A number of abnormalities were encountered in more than one third of the patients studied, including inflammatory sinus disease (19.2%), cysticercosis (3.9%), unruptuted cerebral aneurysm (2.6%), basilar impression (2.6%), intracranial lipoma (2.6%), arachnoid cyst (2.6%), empty sella (2.6%), intracranial neoplasm (2.6%), and others (2.6%). None of these lesions were symptomatic or responsible by the headache picture, therefore, considered incidental findings. In conclusion, the fortuitous encounter of some abnormalities on CT scan of the head is often higher than what we could predict in patients suffering migraine or tension-type headache. We briefly discuss clinical, epidemiologic, and practical management of some of the abnormalities detected by CT scan as well as the indication to request a neuroimaging investigation.KEY WORDS: headache, migraine, tension-type, CT scan, basilar impression, cysticercosis. T T T T Tomografia computadorizada do crânio em pacientes com migrânea ou cefaléia tensional omografia computadorizada do crânio em pacientes com migrânea ou cefaléia tensional omografia computadorizada do crânio em pacientes com migrânea ou cefaléia tensional omografia computadorizada do crânio em pacientes com migrânea ou cefaléia tensional omografia computadorizada do crânio em pacientes com migrânea ou cefaléia tensional RESUMO -Um estudo retrospectivo foi realizado visando avaliar a frequência de anormalidades encontradas durante a realização de estudo por tomografia computadorizada (TC) em 78 pacientes com migrânea ou cefaléia do tipo tensional. A TC foi normal em 61,5% dos pacientes examinados. Em um terço dos pacientes estudados foram detectadas anormalidades, como doença inflamatória dos seios paranasais (19,2%), cisticercose (3,9%), aneurisma cerebral não-roto (2,6%), impressão basilar (2,6%), lipoma intracraniano (2,6%), cisto aracnoideo (2,6%), sela vazia (2,6%), neoplasia intracraniana (2,6%) e outras afecções (2,6%). Nenhuma destas lesões era sintomática (achado incidental). Concluindo, o encontro fortuito de algumas anormalidades na TC é frequentemente mais elevado do que se prediz em pacientes com cefaléia primária. Nós discutimos brevemente alguns aspectos clínicos, epidemiológicos e da conduta terapêutica-cirúrgica sobre algumas das anomalias diagnosticadas pela TC. Também levantamos, ou questionamos, aspectos éticos que determinam o limite entre o direito do paciente e o direito do médico em afirmar que um indivíduo com dor de cabeça não é portador de lesão intracraniana, baseado na história clínica e no exame físico do paciente.

Calcified neurocysticercosis among patients with primary headache

“…This association, however, has been considered as fortuitous by others, who did not find a pathophysiological rational basis to explain the development of chronic headache as the result of parenchymal brain calcifications or a single granuloma (5). We conducted a study in a large cohort of patients to determine whether neurocysticercosis is associated with the occurrence of 'primary headache disorders' and to discuss the possible explanations to this association.…”

Assessment of Cranial Imaging Findings in Patients with Migraines

“…In that retrospective study involving 202 patients with migraines, 78.8% of the cases had normal imaging findings compared with 19.2% who had benign abnormalities. In another study involving 78 patients with migraines or tension headaches, no pathological conditions associated with headaches could be detected in CT (computed tomography) imaging, in which 61.5% of the subjects had normal findings and 38.5% had intracranial benign structural lesions with no accompanying symptoms (9). In a meta-analysis by Frishberg, pathological lesions were detected in 0.4% of 897 migraine patients, and these results are similar to figures reported by Sudlow who reported pathological lesions in 0.2% of 1,086 cases with migraines (10,11).…”

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

“…Previous studies documented that headaches with CWC including sudden onset, altered characteristic, increased frequency or severity, lack of response to therapy, and accompanied focal neurological signs or symptoms may be associated with a neurological disorder (Silberstein, 1992; Dalessio, 1994; Newman and Lipton, 1998; Fabbrini et al. , 1999; Valenca et al. , 2002).…”

“…However, migraine often onsets abruptly. Valenca et al. (2002) reported that there was unruptured cerebral aneurysm in 2.6% of patients with primary headache.…”

“…Forsyth and Posner (1993) reported that 48% of brain tumour patients displayed headaches that resemble migraine and tension‐type headache in 9 and 77% of cases, respectively. In a retrospective study, Valenca et al. (2002) found abnormal findings including unruptured aneurysm, arachnoid cyst, and brain tumour, on CT‐scan of 38.5% of patients with primary headache.…”