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Yield of head computed tomography in patients with new onset of transient headaches
Author(s) -
Hammond Niamh,
Ranta Annemarei
Publication year - 2017
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.13517
Subject(s) - medicine , headaches , computed tomography , yield (engineering) , transient (computer programming) , head (geology) , pediatrics , radiology , surgery , materials science , geomorphology , computer science , metallurgy , geology , operating system
Background Headache is a common patient complaint. The threshold for brain imaging in headache is debated, especially when the headache is transient, although even if the headache has resolved at presentation, a sentinel bleed heralding a subarachnoid haemorrhage ( SAH ) often remains a concern. Aim To assess the yield of computed tomography ( CT ) head scan referrals for patients with transient headache symptoms. Methods This study looked at 6 months of CT results in order to assess for brain pathology, with a particular focus on subarachnoid haemorrhage. Where any pathology was identified, detailed chart review looked for potential high‐risk indicators. Results Between January and July 2015, 531 undifferentiated headache patients were referred for head CT . Of these, 177 (33.3%) presented with a transient or episodic pattern. None of these cases had SAH on imaging nor re‐presented with SAH within 3 months of initial CT . However, 7.3% (13/177) had other significant intracranial pathologies. The only significant risk factor for CT abnormality in this setting was focal neurology on presentation (odds ratio 3.1 (95% confidence interval ( CI ) 1.2–11.0); P = 0.044). All identified cases of SAH over the 6‐month study period occurred in patients with persistent headache, and their clinical presentations showed a similar cluster of symptoms to previous literature (including thunderclap headache, vomiting and loss of consciousness). Conclusion This study suggests that patients with transient headache are at a low risk of SAH ; however, further study is needed to quantify this, and other serious pathologies remains a concern, especially in the setting of focal neurology at presentation.