As we have seen in previous blogs, headache is a common disorder with many potential causes.
The primary headache disorders, which include migraine, cluster and tension-type headahces account for the majority of headaches, while secondary headaches, which are those with underlying pathology (eg tumor, aneurysm, or giant cell arteritis) are far less common. Most patients with headache symptoms do not have a serious underlying condition. However, serious conditions do exist. So...when is the right time to look at further investigations and tests?
The US Headache Consortium identified three consensus-based (not evidence based) general management principles:
1. Testing should be avoided if it will not lead to a change in the management of the headache
2. Testing is not recommended if the individual is no more likely than the general population to have a significant abnormality.
3. Exceptions can be made for patients that are disabled due to the fears of serious pathology, even in the absence of known predictors of abnormalities on neuroimaging studies.
Further guidelines for further investigations stem off the findings from a professionals examination, such as history, examination and more specific examination findings.
Guidelines are as follows
- Neuroimaging should be considered in patients with non-acute headache and an unexplained abnormal neurological examination finding
- Further imaging should be considered when the headache is worsened by Valsalva (bearing down) maneuver, the headache wakes the patient from their sleep, a new headache in the older population, or progressively worsening headache
- Neuroimaging for migraine is not usually warranted for patients with a normal neurological examination.
- Data was insufficient to make an evidence-based recommendation on those presenting with tension type headache. It is therefore up to the practitioner's judgement and available management principles.
As the guidelines suggest, the health practitioner you seek will use not only the guidelines from the American Academy of Neurologists and the US Headache Consortium, but also their individual experience and the patients expectations. Although headaches are grouped into classes, we know that everyone is an individual and their case is never identical to another case.
At our Mudgee Chiropractic practice we aim to understand your case in your own individual circumstance. If we feel that neuroimaging for suspected pathology is required, we are able to refer to our specialist peers for an opinion. It's important to note, that most headaches are not due to a serious pathology and can be treated without serious intervention.
Frishberg et al, Evidence-Based Guidelines in the Primary Care Setting: Neuroimaging in Patients with Nonacute Headache. Guidelines from the US Headache Consortium; American Academy of Neurology , 2005
Written by Dr Ryan Hislop - Chiropractor @ Mudgee, NSW