Clinical predictors of significant intracranial computed tomography scan findings in adults experiencing headache disorder
Open Access
- 19 March 2020
- journal article
- research article
- Published by Pan African Medical Journal in Pan African Medical Journal
Abstract
INTRODUCTION: Radiological assessments for adult headache disorder show significant intracranial findings in 2.5 to 10% of performed CT-scans, leading to an overuse consideration for CT-scan requests by physicians in headache-experiencing patients. Therefore, we undertook this study in order to determine predictors of significant intracranial CT-scan findings in adults experiencing headache disorder; in order to help physicians better select patients who need imaging, which would subsequently decrease the costs of headache disorder management and the useless irradiation rates. METHODS: we carried out a cross-sectional study in the medical imaging departments of Yaounde Central Hospital and Douala Laquintinie Hospital, which are two teaching hospitals in Cameroon, over a period of five months. We consecutively and non-exhaustively included all consenting patients aged eighteen years and above, referred to the radiology department to perform a head CT-scan as aetiological workup of headache disorder, from either a traumatic or non-traumatic mechanism. Patients having a known brain lesion and those with a Glasgow coma scale less than thirteen were excluded. The clinical history of patients was taken and a complete physical examination was performed. Demographic data, clinical characteristics of the headache, results of neurological and physical examinations were collected and correlated to the results of head CT-scan. RESULTS: we enrolled 169 patients in the study, 56.2% were males, with a sex ratio of 1.3; sudden onset of headache increased by two the risk of discovering significant intracranial pathology (p= 0.032). Occipital and cervical location of headache, headache evolving by crisis, and recurrent paroxysmal headache were rather significantly correlated to no structural brain finding. An abnormal neurological examination with specifically abnormal stretch reflexes, aphasia, loss of consciousness, raised intracranial signs, weakness, and meningeal signs were predictive of structural intracranial pathology. Otorrhagia, epistaxis, and periorbital ecchymosis in addition were predictive in post-traumatic headaches. CONCLUSION: abnormal results from neurological examination are the best clinical parameters to predict structural intracranial pathology on CT-scan in adult patients experiencing headache disorder. In case of post-traumatic headaches, in addition, otorrhagia, epistaxis, and periorbital ecchymosis are too highly predictive.Keywords
This publication has 20 references indexed in Scilit:
- Classification and clinical features of headache patients: an outpatient clinic study from ChinaThe Journal of Headache and Pain, 2011
- Patterns of Care and Outcomes After Computed Tomography Scans for HeadacheAmerican Journal Of Medicine, 2011
- Should non acute and recurrent headaches have neuroimaging before review by a Neurologist?- A review in a Southern Nigerian Tertiary HospitalAnnals of African Medicine, 2011
- Clinical Policy: Neuroimaging and Decisionmaking in Adult Mild Traumatic Brain Injury in the Acute SettingAnnals of Emergency Medicine, 2008
- Headache in the emergency department. How to handle the problem?Neurological Sciences, 2008
- Computed Tomography — An Increasing Source of Radiation ExposureThe New England Journal of Medicine, 2007
- Céphalées aiguësEMC - Médecine, 2004
- Indications for Computed Tomography in Patients with Minor Head InjuryThe New England Journal of Medicine, 2000
- Cost‐effectiveness of Computed Tomography in the Evaluation of Patients With HeadacheHeadache: The Journal of Head and Face Pain, 1995
- Computed Tomography in the Headache Patient: Is Routine Evaluation Really Necessary?Headache: The Journal of Head and Face Pain, 1993