Diagnostic imaging for headaches can lead to a plethora of incidental findings, many of which may prompt more worries and needless procedures, according to a new paper, discussed here. But headache specialists say unnecessary imaging can be avoided if neurologists follow certain diagnostic processes, including a thorough neurologic exam.
It happens often. A magnetic resonance imaging (MRI) scan is ordered for a patient with nagging headaches and the scan turns up “an incidental finding,” which may simply be a benign cyst or a normal anatomical variation. But now the patient has two reasons to be anxious: the headaches and the surprising discovery inside his head.
These are only two of many scenarios that can unfold when MRI is used to evaluate headaches, according to a paper published in May in the journal Headache.
About 90 percent of all headaches are the primary type where MRI scans of the brain will not reveal any pathology responsible for headaches. Yet in a significant number of cases — upwards of about 30 percent according to one study cited in the article — the scan reveals an incidental finding such as a small pineal cyst or white matter lesions. Such findings may lead to not only worry, but, in some instances, follow-up testing and even surgery. But most incidental findings are not the cause of the headaches.