Computed tomography evaluation of patients with chronic headache.
OBJECTIVE
To determine whether the rate of detecting a tumour, arteriovenous malformation (AVM) or aneurysm with the use of enhanced or unenhanced computed tomography (CT) is significant in patients with chronic headache and to calculate the cost.


METHODS
Case series.


METHODS
Chronic headache clinic at a tertiary care referral centre.


METHODS
All 373 consecutive patients with chronic headache (284 women, 89 men) referred for CT scanning from May 1987 to October 1992 who met one or more of the following criteria: increased severity of symptoms or resistance to appropriate drug therapy (287 patients [76.9%]), change in characteristics or pattern of headache (78 [20.9%]) or family history of intracranial structural lesion (8 [2.1%]).


METHODS
CT scans of the head were enhanced with nonionic contrast medium (292 scans), were unenhanced (70) or involved both methods (40).


METHODS
Number and nature of minor and major findings, and total price per scan.


RESULTS
Of the 402 CT scans 14 (95% confidence interval [CI] 7 to 21) revealed minor findings that did not alter patient management: infarct (9 scans), cerebral atrophy (2), cavum vergae (1), hyperostosis frontalis interna (1) and communicating hydrocephalus (1). Four scans (95% CI 0 to 8) showed significant lesions: osteoma (2), low-grade glioma (1) and aneurysm (1); only the aneurysm was treated. There were no cases of AVM. An unenhanced scan cost $82.63 and an enhanced scan $204.05. The cost per significant finding was over $18,000. In all, it cost $74,243 to find one treatable vascular lesion.


CONCLUSIONS
The detection rate of CT scanning in patients with chronic headache is similar to that expected in the general population, provided the neurologic findings are normal. The cost of detecting intracranial lesions in this patient population is high [corrected].
Dumas
M D
MD
Department of Radiology, University of Western Ontario, London.
Pexman
J H
JH
Kreeft
J H
JH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001927:Brain Diseases / Q000150:complications / Q000000981:diagnostic imaging; D002908:Chronic Disease; D003365:Costs and Cost Analysis; D005260:Female; D006261:Headache / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D006957:Hyperostosis Frontalis Interna / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000191:economics