title: Factors associated with significant MRI findings in medical walk-in patients with acute headache.
abstract: Acute headache is a main reason for emergency consultations and can be a symptom of dangerous neurological conditions. We hypothesised that in medical walk-in headache patients with low suspicion of intracranial bleeding significant findings in brain magnetic resonance imaging (MRI) are associated with clinical features.
  
  
  
  Retrospective chart review on medical outpatient referrals for brain MRI (2010-2014) with the chief complaint "acute headache" (duration <4 weeks). MRI findings were classified by relevance (significant yes/no) and whether they potentially caused headache. Stepwise logistic regression analysis was applied to identify clinical features associated with pathological findings.
  
  
  
  Among 513 MRI examinations, acute headache was the second most common reason for a brain MRI (n = 82, 16%). Of those, forty-one (50%) were completely normal, 16 (19.5%) had an "nonsignificant" finding not causing headache, 10 (12%) had a nonsignificant finding potentially explaining the headache, 8 (9.8%) a "significant" finding probably explaining the headache, and 7 (8.5%) a significant finding probably not causing headache. Syncope (odds ratio [OR] 31.4, 95% confidence interval [CI] 1.7-570), vomiting (OR 7.5, 95% CI 1.2-46.4), ophthalmological symptoms (OR 3.9, 95% CI 1.0-15.6) and female gender (OR 3.1, 95% CI 0.7-13.7) were associated with significant MRI findings. A clinical score based on these variables was associated with a significant MRI finding potentially causing headache with high sensitivity and specificity.
  
  
  
  Among walk-in patients who underwent MRI for acute headache with low suspicion for intracranial bleeding, 20% had a significant MRI finding. A simple clinical score identified all patients with significant findings that explained the headache. If prospectively validated, this might be a useful tool in selecting those walk-in headache patients requiring urgent cranial MRI.
authors.affiliation: Medical Outpatient Clinic, University Hospital Basel, Switzerland.
authors.forename: Joris
authors.initials: J
authors.lastname: Budweg
authors.affiliation: Department of Neurology, University Hospital Basel, Switzerland, and Department of Neurology, DKD Helios Klinik Wiesbaden, Wiesbaden, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Sprenger
authors.affiliation: Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Basel, Switzerland.
authors.forename: Anthony
authors.initials: A
authors.lastname: De Vere-Tyndall
authors.affiliation: Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Basel, Switzerland.
authors.forename: Anne
authors.initials: A
authors.lastname: Hagenkord
authors.affiliation: Division of Diagnostic and Interventional Neuroradiology, Department of Radiology, University Hospital Basel, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Stippich
authors.affiliation: Medical Outpatient Clinic, University Hospital Basel, Switzerland, and Department of Biomedicine, Translational Immunology, University Hospital Basel, Switzerland.
authors.forename: Christoph T
authors.initials: CT
authors.lastname: Berger
mesh_terms: D000208:Acute Disease; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D001921:Brain / Q000000981:diagnostic imaging; D005260:Female; D006261:Headache / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013557:Switzerland