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

Abstract EN

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.