Cranial Ct Scan Findings In Patients With Headache

Objectives : 140 patients with non specific headache referred from neurology and medical outpatient clinics were studied to review the cranial computerized tomography findings and check if there were any significant lesion detected by CT scan. Methods : The patients were assessed using CT apparatus Siemens Somatom Emotion soft ware version A40A at Al-diwanyia teaching hospital during the period from July 2008 to September 2009 .


Introduction
Headache is one of the most common symptoms that neurologists evaluate. 1 The cause or type of most headaches can be determined by a careful history supplemented by a general and neurological examination and by applying the strict criteria proposed by the International Headache Society ( IHS ) 2 .The official International Headache Society or "IHS"criteria for headache are: 1. Migraine : recurrent headaches separated by symptom-free intervals and accompanied by any three of the following: -abdominal paincomplete relief after sleep -nausea or vomiting -aura (visual, sensory, motor) -hemicrania -throbbing , pulsatile quality and/or positive family history of migraine.
-Migraine without aura -Migraine with aura -Transformed (chronic )migraine. 2. Tension type headache : either episodic tension-type headache or chronic tension-type headache ( with or without medication overuse ) .
3. Cluster Headache and chronic paroxysmal hemicrania 4. Chronic daily headache unassociated with structural lesion including : -new daily persistent headache ( with or without medication overuse ) .
-Hemicrania continua ( with or without medication overuse ). Headache disorders are divided into 2 subgroups -primary and secondary according to the criteria proposed. 3 Ninety percent of the people have complaints of headache at least once during their lives, and it is impossible to perform neuroimaging studies in all of them. 4 There are at least two reasons that make the patient consult a physician for headache: a) Because he or she is afraid of having an intracranial lesion such as brain tumor or aneurysm . b) Because the pain is severe enough to negatively influence her or his quality of life. 5 Neuroimaging should always be requested in the case of the presence of alarm signs (red flag signs): 6 , 7 1) Abnormalities in neurological examination .
2) Atypical headache not completely fulfilling IHS criteria.
3) Changes in headache pattern . 4) Lack of response to therapy. 5) Presence of abnormalities in other investigations, such as skull x-ray and EEG. 6) Headache in patients with extracranial neoplasm. In this retrospective study, we aimed to review the cranial computerized tomography (CT) findings in patients with non specific headache and check if there were any significant lesion detected by CT scan.

Material and Methods
This is a retrospective analysis of CT findings of with headache as primary complaints , not completely fulfilling international headache society criteria. 81 ( 57.9 %) of them were females males whose ages ranged between They referred to our department ( radiology department in Al-diwanyia teaching hospital ) from neurology and medical outpatient clinics from July 2008 CT apparatus was Siemens Somatom Emotion soft ware version A40A . CT images were taken with 5 mm slices enhancement were done to confirm the diagnosis in patients with cerebral tumors .

Results
After analysis was completed, resul main groups on the basis of imaging findings: Group 1: No abnormality detected in cranial CT scan examination of 107 patients ( 76.4 females, and 42(39.3 %) were males between 12 to 66 years.
Abnormal CT findings divided into : There were 12 patients with sinusitis or sclerotic mastoid air cells (  Table 1), 10 patients with intracranial space occupying lesion This is a retrospective analysis of CT findings of 140 patients with headache as primary complaints , not completely fulfilling international headache society criteria.
of them were females, and 59 ( 42.1 %) were males whose ages ranged between 12 to 80 years.
They referred to our department ( radiology department in diwanyia teaching hospital ) from neurology and medical 2008 to September 2009. CT apparatus was Siemens Somatom Emotion soft ware mm slices , intravenous contrast enhancement were done to confirm the diagnosis in patients After analysis was completed, results were divided into two main groups on the basis of imaging findings: No abnormality detected in cranial CT scan 76.4 %) , 65(60.7%) of them were were males , whose ages ranged those with abnormal cranial CT scan examination .
18( 54.5%) of them were females, whose ages ranged between 14 to Abnormal CT findings divided into : s with sinusitis or sclerotic mastoid air cells( patients with intracranial space occupying lesion ( SOLs) ( patients with cerebral atrophy (

Discussion
Headache is the most frequent reason for asking a neuroimaging study. 4 Standard textbooks advice consideration of imaging procedures for patients if there is a suspicion of various brain tumors, epidural-subdural-intracerebral hematoma, hydrocephalus, cerebral abscess and meningeal carcinomatosis. 8 There are a few case reports in which patients with chronic headaches and no additional findings had gross intracranial pathologies detected by CT. 6 The present study demonstrated that CT scan was abnormal in 23.6 % of the patients with non specific headache.
The chance of para-nasal sinuses or mastoid abnormalities were 8.6 % , 7.1% of patients show intracranial SOLs , 5.7 % of patients show cerebral atrophy , 2.2 % of patients show cerebral infarctions .
For our patients, results were comparable to one of the previous Study , Sargent et al studied chronic headache of unspecified type Scans , for the overall group contrary, Akpek studied 592 chronic headache and didn't find any significant abnormality. 10 10 patients with abnormal CT examination cerebral atrophy and 2 patients with old cerebral infarctions are elderly patients whose ages ranged between ,these changes particularly the generalized cerebral atrophy is routine concomitant of the ageing process and is a normal finding in elderly , increasing with age percentage of detected abnormality in our study in comparison with other studies may be related to those elderly patients involved . 10 ( 7.1% ) patients show intracranial SOLs which is significant percentage confirm that significant lesions cab be detected by cranial CT scan in Iraqi patients with non specific headache ( second aim of our study ) . For our patients, results were comparable to one of the Sargent et al studied 177 patients with chronic headache of unspecified type with unenhanced CT for the overall group 28% abnormal . 9 But on the chronic headache and didn't find ients with abnormal CT examination ( 8patients with patients with old cerebral infarctions ) whose ages ranged between 60 to75 years ,these changes particularly the generalized cerebral atrophy is tant of the ageing process and is a normal finding in elderly , increasing with age 11 , so higher percentage of detected abnormality in our study in comparison with other studies may be related to those elderly patients ow intracranial SOLs which is significant percentage confirm that significant lesions cab be detected by cranial CT scan in Iraqi patients with non specific headache ( second aim of our study ) .