Computed tomography in management of patients with non-localizing headache.
OBJECTIVE
To assess the usefulness of a computed tomography scan in patients with non-localized headache.


METHODS
One-hundred and forty-two patients with non-localized headache were included in a retrospective study after reviewing the medical records of 896 patients at the Radiology Department, Sultan Qaboos University Hospital. Patients with neurological deficits, head injury, previous intracranial intervention, or malignancy were excluded. Radiological findings of all patients were reviewed and results were divided into 3 groups: 1) no intracranial abnormality; 2) with clinically significant intracranial abnormality; and 3) positive without clinical significance or with extracranial abnormality. All patient history records were reviewed for a period of six months following their initial computed tomography scan to assess their clinical outcomes. The cost of computed tomography examination and patient radiation dose were calculated.


RESULTS
Of the 142 patients, 64% were females and 36% males (7% pediatric) with an age range of 4-87 years (mean: 36.2 years). Among the patients, 70% demonstrated negative computed tomography findings (grade 1), only 4% showed clinically significant findings (grade 2), and 26% demonstrated incidental positive findings with no clinical significance (grade 3). The average cost of computed tomography head examination was approximately 60 Omani Riyal ($156). The clinically significant positive cases were fewer than expected. The average estimated radiation dose for these patients was calculated and found to be around 5 times the radiation from computed tomography of the sinuses (approximately 1.84 mSv).


CONCLUSIONS
Computed tomography head imaging in patients with non-localized headache has a low likelihood for any significant intracranial lesion. Therefore, it is essential to develop local standard operating procedures to promote better utilization of this type of imaging service.
Nuclear Medicine Fellow (at Institute of Nuclear Medicine, University College London Hospitals); Oman Medical Specialty Board, Muscat, Sultanate of Oman.
Khalsa
K
Al-Nabhani
Consultant Radiologist, Radiology Department, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman.
Anupam
A
Kakaria
Consultant in Radiology and Nuclear Medicine, Institute of Nuclear Medicine, University College London Hospital, London, UK.
Rizwan
R
Syed
CT head; Computed tomography; Non-focal headache; Non-localized headache