Computed Tomography in the Headache Patient: Is Routine Evaluation Really Necessary?

Authors

  • Craig S. Mitchell LCDR, MC, USNR,

    Corresponding author
    1. Department of Radiology, Naval Hospital, San Diego, California and
    2. Department of Clinical Investigation, Naval Hospital, San Diego, California.
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  • Robin E. Osborn CDR, MC, USNR,

    1. Department of Radiology, Naval Hospital, San Diego, California and
    2. Department of Radiology, Mercy Medical Center, 1343 Fountain Boulevard, Springfield, Ohio 45504.
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  • Scott R. Grosskreutz LCDR, MC, USNR

    1. Department of Radiology, Naval Hospital, San Diego, California and
    2. Department of Radiology, Naval Hospital, Okinawa, Japan.
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LCDR Craig S. Mitchell, MC, USNR, c/o Clinical Investigation Dept., Navel Hospital, San Diego, California 92134-5000.

Abstract

SYNOPSIS

Objective. To determine the likelihood ratio of a positive computed tomogram of the brain in the routine evaluation of headache patients.

Design. Consecutive patients with a chief complaint of headache were prospectively evaluated with computed tomography of the brain. Patients with headaches complicating other clinical disorders such as trauma, postictal state or known intracranial neoplasm were excluded.

Setting. Military tertiary care center.

Patients. Consecutive sample of 350 patients with a chief complaint of headache, regardless of the presence or absence of physical or neurologic signs, were referred for computed tomography of the brain. The patients were referred from a variety of inpatient and outpatient settings.

Results. Seven (2%) of the 350 patients had computed tomographic findings that were clinically significant. An additional 25 (7%) had positive computed tomographic findings, which were clinically insignificant for findings. All of the patients with significant computed tomographic findings had an abnormal physical or neurologic exam or unusual clinical symptoms.

Conclusion. Routine computed tomography of the brain in headache patients with normal physical and neurologic exams and no unusual clinical symptoms has a low likelihood ratio for discovering significant intracranial disease.

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