1) A study examined neuroimaging results from 530 new headache patients referred to an outpatient consultation service over 5 years. 2) Significant abnormalities were found in 11 patients (2.1%), including 6 brain tumors. 3) Migraine and tension-type headache patients had similar low rates of significant abnormalities (1.2% and 0.9%) as seen in normal individuals (0.7-2%). 4) The study supports selective neuroimaging in headache patients based on worrying features, as prevalence of significant findings is low.

1. IMAGING RESULTS IN A CONSECUTIVE SERIES OF 530 NEW PATIENTS IN THE BIRMINGHAM HEADACHE SERVICE NEUROLOGY JOURNAL CLUBKSHITIJA KARI, MDPGY-III

2. INTRODUCTIONWhich patients with headache disorders should undergo neuroimaging?UK & USA guidelines (National Institute for Health, American Academy of Neurology) suggest selective policy for imaging as prevalence of significant findings is lowHigh referral rate leads to increased discovery of incidental findings on imagingHowever, clinicians continue to refer such patients for imaging for reassurance and patient satisfaction

3. STUDY DESIGNSingle center, prospective observational study over a period of 5 yearsBirmingham Headache ServiceOutpatient consultation service3 consultants

4. 1 diagnostic headache nurse specialist

5. Imaging performed in the same hospital and reported by general radiologists.METHODSPatients referred to outpatient consultation service.The nurse takes a headache and general medical history and performs a neurological exam.Diagnosis based on ICHD-2 classification (International Classification of Headache Disorders).50% of new patients discussed with consultants regarding imaging.Guidance for general practitioners on imaging in headache (Imaging patients with suspected brain tumor: guidance for primary care. Kernick DP, Br J Gen Pract 2008).

6. METHODSRoutine imaging ‘orange/yellow flags’:recent headache, change in character

7. no diagnostic pattern, wakes from sleep

8. Precipitated by coughing, straining, etc.

9. hemiplegic migraine, cluster headacheUrgent imaging ‘red flags’:raised intra cranial pressure

10. focal neurological signs

11. epilepsy

12. cognitive disturbance

13. recent diagnosis of cancerMETHODSSignificant abnormalities: 1º or 2º brain tumorChiari abnormalityInsignificant abnormalities: Arachnoid cystcerebrovascular diseasewhite matter abnormalitiesNormal findings.

14. RESULTSAug 2004 – July 2009, 3655 new patients seen

15. 69% female, mean age 42yrs

16. 56% white, 34% Asian and 11% Afro-Caribbean

17. Total of 530 of the 3655 patients were referred for imaging

18. Differences in proportion of patients imaged by the 3 consultants

20. RESULTS