Cost‐effectiveness of Computed Tomography in the Evaluation of Patients With Headache

Abstract

We report a retrospective study to determine the cost-effectiveness of cranial computed tomography in patients with headache without neurological finding. Five hundred ninety-two neurologically normal patients were examined between 1990 and 1993 for the complaint of headache. Examination results were reevaluated from written report and image archive systems. Results were divided into three groups. In group P0, we included patients with normal cranial computed tomography findings. In group P1, patients showed some minor pathologies like ischemic or atrophic changes. These findings neither explained the reason for headache nor changed the clinical or therapeutic approach. The third group (P2) was to include patients with gross intracranial pathology like space-occupying lesions or bleeding. Five hundred forty-six of 592 patients were in the P0 group (92%), and the remaining 46 patients were in the P1 group (8%). No patient was found to have serious intracranial pathology detected by computed tomography. Cost of detection of a case with significant pathology was calculated. It is our opinion that computed tomography is an unrewarding technique in the evaluation of patients with chronic headache whose neurological examinations are normal.

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

“…[4] Though neuroimaging has revolutionized the investigation of headache and headache syndromes in general, the low yield in non traumatic, non focal, chronic and recurrent headaches and the cost implication particularly in resource poor settings are well known. [5][6][7] Similar trends of low yield have also been reported in the emergency evaluation of acute non focal headaches in the emergency department and in one large series only 1.02% had clinically significant findings requiring a change of management on neuroimaging. [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.…”

Computed tomography for non-traumatic headache in the emergency department and the impact of follow-up testing on altering the initial diagnosis

“…In the setting of non-traumatic headache as an isolated symptom, with no focal neurologic deficits, most patients can be managed safely without radiologic imaging [2]. Multiple previous studies have demonstrated that computed tomography (CT) and magnetic resonance imaging (MRI) evaluation in this patient population is of extremely low yield [2][3][4][5]. Unfortunately, emergency physicians often face intense pressure from patients and often feel compelled to obtain imaging, even in those who could be treated conservatively [2].…”

Appropriate Use of Neuroimaging in Headache

“…Several studies have noted the low cost-effectiveness of CT imaging in patients with no abnormalities on neurological evaluation, citing that the cost of finding a case of brain tumor was estimated to be at least US$1265 for patients with abnormalities on neurological examination and US$11,901 for patients with normal findings on neurological examination [28][29][30].…”