Significant and nonsignificant findings on magnetic resonance imaging of patients with headache

Abstract

Aim: The great majority of people suffer from headaches. Neuroimaging has a very limited role in determining the etiology of headache However, neuroimaging, especially magnetic resonance imaging (MRI), is requested for the vast majority of patients with headache. We aimed to determine the frequency of clinically significant and nonsignificant findings on brain MRI in patients with headache, and the factors associated with these findings.
 Material and Method: A total of 350 patients (231 women and 119 men), who underwent MRI examinations for headache complaints, were included in the study. Based on the evaluation of lesions detected on MRI and headache characteristics together, lesions associated with headache were classified as significant findings, and lesions unrelated to headache were classified as nonsignificant findings. Patients were compared in terms of brain MRI findings on the basis of age, gender, and duration of headache complaints.
 Results: Assessment of brain MRIs revealed normal findings in 211 (60.3%) patients, nonsignificant findings in 122 (34.8%) patients, and significant findings that could cause headache in 17 (4.9%) patients. The most common significant lesions were acute sinusitis, acute cerebrovascular accident, cerebral venous sinus thrombosis and aneurysm. In patients over 65 years of age, the frequency of significant findings was significantly higher (p:0.001). The frequency of significant findings was higher in male patients and patients with a headache duration of less than one month, but there was no statistical difference (p:0.452 and p:0477). 
 Conclusion: We found significant findings on brain MRI in approximately 5% of patients with headache. Being over 65 years old and acute onset headache increase the probability of detecting significant lesions on MRI. Despite its low diagnostic value, physicians will often refer patients with headaches to neuroimaging for fear of missing a critical underlying lesion and encountering medico-legal issues. Taking into account worrying red flags can increase the likelihood of finding significant lesions.