Brain MR imaging in the evaluation of chronic headache in patients without other neurologic symptoms

Rationale and Objectives. The authors investigated the use of magnetic resonance (MR) imaging of the brain in adult patients with a primary complaint of chronic headache and no other neurologic symptoms or findings and determined the yield and MR predictors of major abnormalities in these patients. Materials and Methods. The medical records and MR images of 402 adult patients with chronic headache were retrospectively reviewed, All patients had been evaluated and referred by the neurology service. The findings were categorized as either negative or positive for major abnormality. Multivariate analysis with a linear logistic regression technique was performed on the clinical data, which included patient age, patient sex, and headache type. Results. Major abnormalities were found in 15 patients (3.7%), consisting of seven women (2.4%) and eight men (6.9%). Major abnormalities were found in 0.6% of those with migraine headaches, 1.4% with tension headaches, none with mixed migraine and tension headaches, 14.1% with atypical headaches, and 3.8% with other types of headaches. Multivariate analysis showed that the atypical headache type was the most significant predictor of major abnormality. Conclusion. The yield of major abnormalities found with brain MR imaging in patients with isolated chronic headache is low. However, those patients with atypical headaches have a higher yield of major abnormalities and may benefit from imaging.