Pitfalls in Neuroimaging of Headache : A Case Report and Review of the Literature

• Published in: Case reports in otolaryngology Vol. 2013; no. 2013; pp. 1 - 3
• Main Authors: Vallamkondu, V., Shakeel, M., Hussain, A., McAteer, D.
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt Hindawi Puplishing Corporation 01.01.2013; Hindawi Publishing Corporation; Hindawi Limited; Wiley
• Subjects: Analgesics; Case Report; Classification; Family medical history; Headaches; Medical imaging; Migraine; Otolaryngology; Pain; Pathology; Patients
• ISSN: 2090-6765; 2090-6773
• DOI: 10.1155/2013/735147

Headache is a common symptom, with a lifetime prevalence of over 90% of the general population in the United Kingdom (UK). It accounts for 4.4% of consultations in primary care and 30% of neurology outpatient consultations. Neuroimaging is indicated in patients with red flag features for secondary headaches. The guidelines recommend CT or MRI scan to identify any intracranial pathology. We present a unique case where the initial noncontrast CT scan failed to identify a potential treatable cause for headache. A middle aged man presented with headache and underwent a CT scan without contrast enhancement. The scan was reported as normal. The headache persisted for years and the patient underwent a staging CT scan to investigate an oropharyngeal cancer. This repeat CT scan utilized contrast enhancement and revealed a meningioma. Along with other symptoms, headache is an established presenting complaint in patients with meningioma. The contrast enhanced CT brain proved superior to a nonenhanced CT scan in identifying the meningioma. In a patient with persistent headache where other causes are excluded and a scan is to be requested, perhaps contrast enhanced CT is a better option than a plain CT scan of brain.