Brain MR imaging in the evaluation of chronic headache in patients withoutother neurologic symptoms

Rationale and Objectives. The authors investigated the use of magnetic reso nance (MR) imaging of the brain in adult patients with a primary complaint of chronic headache and no other neurologic symptoms or findings and determ ined the yield and MR predictors of major abnormalities in these patients. Materials and Methods. The medical records and MR images of 402 adult patie nts with chronic headache were retrospectively reviewed, All patients had b een evaluated and referred by the neurology service. The findings were cate gorized as either negative or positive for major abnormality. Multivariate analysis with a linear logistic regression technique was performed on the c linical data, which included patient age, patient sex, and headache type. Results. Major abnormalities were found in 15 patients (3.7%), consisting o f seven women (2.4%) and eight men (6.9%). Major abnormalities were found i n 0.6% of those with migraine headaches, 1.4% with tension headaches, none with mixed migraine and tension headaches, 14.1% with atypical headaches, a nd 3.8% with other types of headaches. Multivariate analysis showed that th e atypical headache type was the most significant predictor of major abnorm ality. Conclusion. The yield of major abnormalities found with brain MR imaging in patients with isolated chronic headache is low. However, those patients wi th atypical headaches have a higher yield of major abnormalities and may be nefit from imaging.