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Research Article | Volume 15 Issue 1 (Jan - Feb, 2025) | Pages 305 - 312
A Study on The Value of Multislice Multidetector Computed Tomography of The Brain in Individuals with Primary and Secondary Headaches in A Tertiary Care Hospital
 ,
 ,
1
Senior resident, Karuna Medical College, Chittor, Palakkad, Kerala. India
2
Associate Professor, Karuna Medical College, Chittor, Palakkad, Kerala. India
3
Professor, Karuna Medical College, Chittor, Palakkad, Kerala. India
Under a Creative Commons license
Open Access
Received
Nov. 29, 2024
Revised
Jan. 3, 2025
Accepted
Jan. 20, 2025
Published
Jan. 25, 2025
Abstract

Background: A headache is one of the most prevalent conditions that individuals encounter frequently. Approximately 90% of individuals experience a headache at least once every year, while around 40% suffer from a severe headache at least once annually.1

OBJECTIVES:

1) to determine the effectiveness of CT brain scans in identifying the underlying causes of headaches.

2) To evaluate the extra benefit of obtaining limited PNS pictures after evaluating the brain in individuals with headaches.

Material & Methods: Study Design: A prospective hospital-based cross-sectional study. Study area: Department of Radio Diagnosis, Karuna Medical College, Chittor, Palakkad, Kerala. Study Period: 1 year. Study population: This cross-sectional study was conducted on 75 patients, who were presented with complaints of head-aches.  Sample size: The study consisted of 75 subjects. Sampling method: Simple random technique. Results: The study was conducted on 75 patients, including 38 females &37 males from the ages of 12 to 84. One-quarter (29.3%) of the subjects were between the ages of 20 and 29, while the average patient age was 35. Isolated headaches and headaches accompanied by vomiting were the two most common complaints that got a CT brain reference. There were 17 subjects with significant pathologies, 13 of whom had intra-cranial pathology & 4 of who had PNS disease. 6 of the 17 positive cases are SOLs, 2AISs, one SAH, four cortical vein thrombosis, &four cases of sinusitis. With a positive likelihood ratio of less than 1, the diagnostic conclusion for primary headache was low. Conclusion:  When assessing individuals with headaches, a CT scan of the brain serves as an effective screening tool that can either identify structural issues or eliminate them from consideration. The additional acquisition of limited PNS sections enhances the imaging yield, lowers the costs associated with dedicated PNS imaging, and aids in distinguishing between headaches originating in the PNS and those arising from other areas in the brain. Patients who experience severe headaches, those that onset suddenly, or headaches accompanied by symptoms such as vomiting, fever, a runny nose, or neurological deficits tend to have a higher diagnostic yield from CT scans.

Keywords
INTRODUCTION

A headache is one of the most prevalent conditions that individuals encounter frequently. Approximately 90% of individuals experience a headache at least once every year, while around 40% suffer from a severe headache at least once annually.1 It represents 4% of all hospital visits and is estimated to result in a cost of $150 million in lost workdays in the United States each year. Patients often seek medical care for headaches for at least two main reasons. The intensity of the pain experienced by the patient, along with their concerns about the possibility of having a brain tumour or aneurysm, are both factors that affect their choice to seek medical assistance.

 

Headaches, a common medical issue, can arise from a multitude of factors. Primary headache disorders consist of migraine, cluster, and tension-type headaches. Secondary headaches tend to be more frequent in individuals who have a pre-existing condition, such as a tumour or aneurysm, while migraine, cluster, and tension-type headaches are the most prevalent forms of primary headache disorders.2 The majority of patients who visit their doctors with headache complaints do not have any significant underlying health issues contributing to their symptoms.3,4

 

Routine imaging procedures such as CT scans to identify possible underlying causes of headaches have come under scrutiny due to the relatively low incidence of secondary headaches in comparison to primary headaches. The main objective of a neuroimaging study is to assist in diagnosing serious, treatable conditions that negatively affect a patient's quality of life, enabling them to receive appropriate treatment. However, there are many other important factors to consider. Using neuroimaging can alleviate patients' fears about having a medical condition, helping them feel more assured about both their health and the care they are receiving. The requests made by patients for neuroimaging studies, or those made by their family members, are valid justifications for obtaining such studies for individuals experiencing headaches. 3,4

 

Very few individuals referred for cranial computed tomography are doing so due to severe headaches. Headaches are the most prevalent concern among patients requiring a CT scan. When addressing individuals who report headaches, considerable emphasis is placed on diagnosing and managing any possible intracranial conditions. Their headaches may stem from intracranial or peripheral nervous system issues, including meningitis, tumours, or other abnormalities of the peripheral nervous system. Headaches can originate from either brain sinuses or nasal sinuses. As computed tomography (CT) scans become increasingly accessible, they are often utilized to exclude brain tumours and other serious neurological disorders in patients who present with headaches. The use of these scans is on the rise.

 

OBJECTIVES:

  • to determine the effectiveness of CT brain scans in identifying the underlying causes of headaches.
  • To evaluate the extra benefit of obtaining limited PNS pictures after evaluating the brain in individuals with headaches.
MATERIALS AND METHODS

Study Design: A prospective hospital-based cross-sectional study.

 

Study area: Department of Radio Diagnosis, Karuna Medical College, Chittor, Palakkad, Kerala.

 

Study Period: 1 year.

 

Study population: This cross-sectional study was conducted on 75 patients, who were presented with complaints of head-aches. 

 

Sample size: The study consisted of 75 subjects.

 

Sampling method: Simple random technique.

 

Inclusion criteria:

All patients (males & females) aged <12 years with headache (acute or chronic) with or without other neurological signs & symptoms.

 

Exclusion Criteria:

  1. Headache due to ophthalmic cause.
  2. With an immediate history of trauma.
  3. Known cases of brain tumors or SOL in the brain.
  4. Pregnant women with headache.

 

Ethical consideration: Institutional Ethical Committee permission was obtained before the commencement of the study.

 

Study tools and Data collection procedure:

The patient was positioned supine for the CT scan of the brain and restricted PNS, with the scan plane parallel to the orbito-meatal plane and at an angle of 10- 25 degrees to Reid's line. When the restricted PNS sections were produced, the segment's plane was oriented toward Reid's line. Serial sections were created using cuts spanning 4 millimetres supratentorial, 2.5 millimetres in the posterior fossa, and 5 millimetres across the PNS. If iodinated contrast media with a mean volume of 25 cc was provided to selected individuals to do a contrast investigation of the brain.

 

Patients' full clinical histories were taken, including details such as the frequency and severity of headaches, their onset and progression, and any accompanying symptoms such as nausea, vomiting, sensitivity to light, difficulty focusing, red eyes, neurological impairments, runny noses, and fevers. Known extra-central nervous system (CNS) malignancies and systemic diseases including hypertension were considered.

 

A tabular form was used to document the results. The predictive output from imaging in patients with simple headaches, headaches with concomitant symptoms such as nausea, vomiting, vision pathologies, and headaches without related symptoms was then statistically analysed. Examining the diagnostic accuracy from imaging in patients with migraine, tension headache, and persistent daily headache, as well as in patients with established systemic disease, was also studied.

 

Statistical analysis:

In the present study, descriptive statistical analysis was done. Results for categorical measurements are reported in Number (%) whereas results for continuous measurements are reported as Mean ±SD(Min-Max). At a 5% level of significance, significance is evaluated.

RESULTS

 

Table 1: Dispersion of ages between those with & those without an imaging pathology.

Pathology on CT

<19years

20-29

years

30-39

years

40-49

years

50-59

years

60-69

years

>70

years

Total

n (%)

n (%)

n (%)

n (%)

n (%)

n (%)

n (%)

n (%)

Present

5(6.66)

12(16)

7(9.33)

5(6.66

)

4

(5.33)

4

(5.33)

1(1.33)

38

(50.65)

Absent

6(8)

10

(13.3)

12

(16)

3

(4)

3

(4)

2

(2.67)

1(1.33)

37

(49.35)

Total

11(75)

22(75)

19(75)

8

(75)

7(75)

6(75)

2(75)

75

(100)

 

Table 2: Statistical analysis of the prevalence of imaging pathologies by gender.

Pathology on CT

Males

Females

Total

n (%)

n (%)

n (%)

Present

18(24)

20(26.6)

38(50.65)

Absent

19 (25.3)

18(24)

37(49.35)

Total

37(49.35)

38(50.65)

75(100.0)

 

Table 3: The Distribution of the length of time a headache lasts, depending on whether imaging was abnormal or not.

Pathology on CT

<1months n(%)

1-3months n(%)

Months n(%)

>6months n(%)

Total n(%)

Present

12(16)

7(9.3)

9(12)

10(13.3)

38(50.65)

Absent

11(14.6)

7(9.3)

8(10.6)

11(14.6)

37(49.35)

Total

23(75)

14(75)

17(75)

21(75)

75(75)

 

Table 4: The prevalence of different types of headaches, both with & without pathologies on imaging.

Pathology on imaging

Diffuse

Focal

Total

n (%)

n (%)

n (%)

Present

30(40)

8(10.6)

38(50.65)

Absent

30(40)

7(9.3)

37(49.35)

Total

60(80)

12(20)

75(100)

 

Table 5: Visual impairment & its distribution concerning imaging pathologies.

CT

pathology

Yes

No

Total

n(%)

n(%)

n(%)

Present

4(5.3)

10(13.3)

14(18.66)

Absent

10(13.3)

51(67.99)

61(81.33)

Total

14(18.66)

61(81.33)

75(100)

 

Table 6: Distribution of Systemic illness with frequency of pathology detected on imaging

Systemic illness

Number of patients

Percent

Frequency of pathology on CT

Percent(%)

Hypertension

15

20

1

5

Carcinoma cervix

2

2.66

2

10

CML

1

1.33

1

5

Viral fever

1

1.33

0

-

Liver  mass

1

1.33

0

-

RHD

1

1.33

1

5

No systemic illness

54

71.8

15

75

Total

75

100.0

20

100

 

 Table 7: Distribution of imaging anomalies in terms of frequency of occurrence.

Pathology detected on CT

Frequency(75)

Percent(%)

Infarct

2(75)

2.66

Cortical vein thrombosis

4(75)

5.32

SAH

1(75)

1.33

SOL

6(75)

8

Sinusitis

4(75)

5.32

Total pathology

17(75)

22.66

Normal CT study

58(75)

77.3

Total

75(75)

100

 

 Table 8: Prevalence of Headache Diagnosis in Clinical Practice.

Clinical diagnosis

Frequency

Percent

Tension Headache

6

8

Chronic daily

Head-ache

16

21.33

Migraine

6

8

Sinusitis

8

10.66

Meningitis

2

2.66

others

37

49.33

Total

75

100.0

 

Table 9: Imaging pathology detection likelihood ratio.

Symptom

Likelihood ratio+

Likelihood ratio-

Only head-ache

0.19

1.22

Head-ache with nausea

0.714

1.02

Head-ache with vomiting

5.17

0.74

Head-ache with fever

3.3

0.75

Head-ache with blurring of vision

2.3

0.85

Head-ache with running nose

5.37

0.55

Severe headache

6.2

0.54

Abrupt on set

4.4

0.68

Systemic illness

2.5

0.84

Migraine

0.81

1.02

TTH

0

1.12

CDH

0.2

1.1

 

Figure 1: 38/M with thrombus may be suspected when there is widespread acute headache and vomiting that shows hyperdense straight sinuses.

Figure 2: 78/ F patient with rapid hypertension and the worst headache the patient ever had both presenting signs of diffuse SAH.

Figure 3: 55/M patient with Prostatic cancer with diffuse headache & vomiting showing SOL in the left cerebellum

Figure 4: 60/Ma meningioma was found in a patient who presented with widespread headache and vomiting and with extra-axial signs of SOL.

Figure 5: An ependymoma was found in the brain of a female patient of age 84 who had had a progressive development of headache and vomiting. Imaging revealed an intra- axial solid- cystic pathology in the right frontal lobe.

 

Figure 6: 10/Ma patient who suffers from recurrent headaches and has been diagnosed with bilateral sphenoid sinusitis.

 

Figure 7: 17/M patient presenting with persistent, widespread headache and a nasal septum that is deviated to the left.