Unnecessary Neuroimaging for Patients With Primary Headaches

Abstract

Background - Headache may be due to either a primary or secondary disorder, and neuroimaging assessments can play an important role when differentiating between these types of headache. Although many studies have reported no significant differences between primary headache patients and the general population in terms of abnormal neuroimaging findings, others have shown that neuroimaging may be employed to rule out secondary causes of headache that could impact morbidity and mortality. This issue remains under debate. Thus, the present study compared the neuroimaging findings of headache patients and healthy controls. Methods - This study recruited 1070 healthy controls and 1070 primary headache patients from the Chinese People's Liberation Army General Hospital. The primary headache patients were diagnosed by computerized clinical decision support systems, and re-diagnosed by a specialist. All participants were assessed with either computed tomography or magnetic resonance imaging (MRI) scans. The neuroimaging findings were classified as significant abnormalities, non-significant abnormalities, or normal. Results - All the significant abnormalities were found using MRI scans. Significant abnormalities were identified in 4 primary headache patients (0.58%) and 5 healthy controls (0.73%); the rate of significant abnormalities was not significant different between both groups (P > .05). Conclusions - The present study found that neuroimaging was unnecessary for the primary headache patients.

Neuroimaging for Migraine: The American Headache Society Systematic Review and Evidence‐Based Guideline

“…Major abnormalities were significantly less common in those with migraine than in other types of headache. The only abnormality among the migraine subjects was a petrous apex cholesterol cyst in a 58 year old woman If anything, patients with migraine are less likely to have significant neuroimaging abnormalities than those with non-migraine headaches 40 compared neuroimaging results between 1070 subjects with headache (including 665 with migraine) and 1070 healthy gender and age matched controls, without "red flags" or abnormal exam findings. None of the 382 subjects undergoing CT had significant abnormalities.…”

“…There were 5 abnormalities in the healthy controls (0.73%) which was not significantly different. 40 Cull 41 studied CT and MRI abnormalities in 69 subjects presenting with "late-onset migraine" starting after the age of 40 with the majority of subjects (86%) having aura. When available, carotid ultrasound and laboratory testing was also reviewed.…”

“…Other than the 40 compared neuroimaging results between 1070 subjects with headache (including 665 with migraine) and 1070 healthy gender and age matched controls, without "red flags" or abnormal exam findings. These studies primarily focused on outpatients with migraine with no indication of exam abnormalities.…”

Automatic migraine classification using artificial neural networks

“…Currently, there is a recurrent problem in the diagnosis and treatment of migraines, which includes, among others, the following needs: (i) proper reading and identification of the patient's primary and secondary symptoms, (ii) precise and timely identification of the type of migraine, (iii) continuous monitoring of the symptoms, and (iv) adequate treatment. In the early stages of the pathology, patients visit the emergency services or outpatient consultation departments, where timely identification largely depends on the expertise of the treating physician and the continuous monitoring of the patient (Burch et al, 2018;Burch, 2019;Deza, 2010;Evans & Johnston, 2011;Trillos, 2010;Wang et al, 2019). However, owing to the scarcity of time to establish a diagnosis, the inexperience of the physician, or shortcomings in the patient-physician communication of symptoms, the pathology is often misdiagnosed or the severity of the disease is underestimated, leading to inappropriate, unnecessary, or imprecise therapies, which can result in complex damages to patients' health (Evans & Johnston, 2011).…”

“…Migraines can be misdiagnosed as tension headache, sinus headache, or other types of headache. A diagnosis of migraine should be considered when there are recurrent and debiliting headaches without secondary warning signs (Burch et al, 2018;Burch, 2019;Wang et al, 2019). Therefore, misdiagnosis or incorrect classification of the type of migraine and inadequate treatment of the pathology constitute the underlying problem associated with migraines (Deza, 2010;Trillos, 2010).…”