Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Dec 8:146:w14349.
doi: 10.4414/smw.2016.14349. eCollection 2016.

Factors associated with significant MRI findings in medical walk-in patients with acute headache

Joris Budweg  1 , Till Sprenger  2 , Anthony De Vere-Tyndall  3 , Anne Hagenkord  3 , Christoph Stippich  3 , Christoph T Berger  4
Affiliations

Factors associated with significant MRI findings in medical walk-in patients with acute headache

Joris Budweg et al. Swiss Med Wkly. .

Abstract

Question: Acute headache is a main reason for emergency consultations and can be a symptom of dangerous neurological conditions. We hypothesised that in medical walk-in headache patients with low suspicion of intracranial bleeding significant findings in brain magnetic resonance imaging (MRI) are associated with clinical features.

Methods: Retrospective chart review on medical outpatient referrals for brain MRI (2010-2014) with the chief complaint "acute headache" (duration <4 weeks). MRI findings were classified by relevance (significant yes/no) and whether they potentially caused headache. Stepwise logistic regression analysis was applied to identify clinical features associated with pathological findings.

Results: Among 513 MRI examinations, acute headache was the second most common reason for a brain MRI (n = 82, 16%). Of those, forty-one (50%) were completely normal, 16 (19.5%) had an "nonsignificant" finding not causing headache, 10 (12%) had a nonsignificant finding potentially explaining the headache, 8 (9.8%) a "significant" finding probably explaining the headache, and 7 (8.5%) a significant finding probably not causing headache. Syncope (odds ratio [OR] 31.4, 95% confidence interval [CI] 1.7-570), vomiting (OR 7.5, 95% CI 1.2-46.4), ophthalmological symptoms (OR 3.9, 95% CI 1.0-15.6) and female gender (OR 3.1, 95% CI 0.7-13.7) were associated with significant MRI findings. A clinical score based on these variables was associated with a significant MRI finding potentially causing headache with high sensitivity and specificity.

Conclusion: Among walk-in patients who underwent MRI for acute headache with low suspicion for intracranial bleeding, 20% had a significant MRI finding. A simple clinical score identified all patients with significant findings that explained the headache. If prospectively validated, this might be a useful tool in selecting those walk-in headache patients requiring urgent cranial MRI.

PubMed Disclaimer