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Topic: Peter Goadsby--when to brain scan (Read 302 times) |
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Bob_Johnson
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Peter Goadsby--when to brain scan
« on: Aug 31st, 2004, 8:22pm » |
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A portion of an editorial in British Medical Journal, 8/28/04.
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To scan or not to scan in headache
Some patients with primary headaches may need imaging
"Some life threatening brain disorders present with secondary headache, where the headache is caused by the disease. A brain tumour, for example, is best diagnosed by brain imaging early in the course of the disease, which is essential for optimal management of this and other secondary headache disorders. However, brain tumours, as an example, account for less than 0.1% of the lifetime prevalence of headache.1 This contrasts with the fact that most headaches in the community are either associated with mild systemic infection or due to primary headache,1 where the headache is itself the disorder. Dissecting primary from secondary headache is the problem, since, by definition, primary headache does not need brain imaging because no disease process exists that leads to macroscopic change in general terms.
"How does one dissect primary from secondary headache? This question can have only a clinical response since no controlled trials have been conducted to identify causes of secondary headache. In clinical practice we generally accept that the so called red flags of headache should trigger a search for secondary headache.2 Thus change in the pattern of headache; new onset of headache in people older than 50; onset of seizures or headache associated with systemic illness, including fever; personality change; or with symptoms suggestive of raised intracranial pressure, such as new onset headache in the early morning; or headache that is worsening with coughing, sneezing, or straining should each be viewed with concern. Acute onset of the worst headache of the patient's life should trigger immediate referral for consideration as a sentinel headache of an intracranial aneurysm. An abnormal neurological finding is a clear indication to investigate, unless the finding is longstanding.2 Fortunately most worsening of headache is probably longstanding primary headache going into a more troublesome period, which mercifully is not a marker of a life threatening problem. "
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Bob Johnson
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pubgirl
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Re: Peter Goadsby--when to brain scan
« Reply #1 on: Sep 1st, 2004, 2:44am » |
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I like that when he writes and speaks in public, I can understand what he is saying
Wendy
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don
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Re: Peter Goadsby--when to brain scan
« Reply #2 on: Sep 1st, 2004, 6:59am » |
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Quote:
Now there is a word I'd like to see more Doc's understand.
Substitute for egotistically.
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