Factors Associated with Incidental Neuroimaging Abnormalities in New Primary Headache Patients

Abstract

Background and Purpose Deciding whether or not to perform neuroimaging in primary headache is a dilemma for headache physicians. The aim of this study was to identify clinical predictors of incidental neuroimaging abnormalities in new patients with primary headache disorders. Methods This cross-sectional study was based on a prospective multicenter headache registry, and it classified 1,627 consecutive first-visit headache patients according to the third edition (beta version) of the International Classification of Headache Disorders (ICHD-3β). Primary headache patients who underwent neuroimaging were finally enrolled in the analysis. Serious intracranial pathology was defined as serious neuroimaging abnormalities with a high degree of medical urgency. Univariable and multivariable logistic regression analyses were conducted to identify factors associated with incidental neuroimaging abnormalities. Results Neuroimaging abnormalities were present in 170 (18.3%) of 927 eligible patients. In multivariable analysis, age ≥40 years [multivariable-adjusted odds ratio (aOR)=3.37, 95% CI=2.07-6.83], male sex (aOR=1.61, 95% CI=1.12-2.32), and age ≥50 years at headache onset (aOR=1.86, 95% CI=1.24-2.78) were associated with neuroimaging abnormalities. In univariable analyses, age ≥40 years was the only independent variable associated with serious neuroimaging abnormalities (OR=3.37, 95% CI=1.17-9.66), which were found in 34 patients (3.6%). These associations did not change after further adjustment for neuroimaging modality. Conclusions Incidental neuroimaging abnormalities were common and varied in a primary headache diagnosis. A small proportion of the patients incidentally had serious neuroimaging abnormalities, and they were predicted by age ≥40 years. These findings can be used to guide the performing of neuroimaging in primary headache disorders.

Diagnostic yield of emergency MRI in non-traumatic headache

“…The proportion of incidental findings discovered was similar to that of the significant findings, and also to that reported for patients with a new primary headache [16]. Kim et al reported incidental abnormalities in 25% of new primary headache patents scanned with MRI, of which white matter hyperintensities and sinonasal abnormalities not related to headache were the most common.…”

Burden of migraine and unmet needs from the patients’ perspective: a survey across 11 specialized headache clinics in Korea

“…The current study reveals that, for Korean patients specifically, the proportion is much higher at 48%. MRI was the most common diagnostic test among respondents, followed by CT, possibly due to MRI being more sensitive than CT in identifying intracranial pathology, and more generally preferred for the evaluation of headaches [32][33][34]. Neuroimaging is not usually warranted for patients who meet the diagnostic criteria for migraine and have normal findings on a neurologic examination.…”

Isolated headache is not a reliable indicator for brain cancer: the 2-week wait pathway for suspected CNS malignancies

“…[21][22][23] Moreover, the prevalence of incidental brain lesions in an asymptomatic population is the same as those presenting with headache, increasing with age in both groups. 24,25 In this study, symptoms suggestive of a raised ICP headache had a strong negative predictive value of CNS cancer, suggesting that, paradoxical to traditional beliefs, with such features the likelihood of CNS cancer is low. This is consistent with cohorts of patients presenting with 'headache of raised ICP' that have shown that neither is this higher in patients with brain tumour nor is it an indicator for raised ICP.…”

“…25,34 This is no different in patients with headache outside the context of thunderclap headache. 24,25 Yet, nevertheless, the tendency to intervene occurs. This is clear from a meta-analysis showing imaging abnormalities in headache patients similar to previous studies, prompting the authors to recommend imaging for headache.…”