Study Type
Study Type
Study Objective(Purpose of Study)
Study Objective(Purpose of Study)
Study Results
Study Results
Study Quality
Study Quality
1. Mafi JN, Edwards ST, Pedersen NP, Davis RB, McCarthy EP, Landon BE. Trends in the ambulatory management of headache: analysis of NAMCS and NHAMCS data 1999-2010. J Gen Intern Med. 30(5):548-55, 2015 May. Observational-Dx 9,362 visits To characterize trends from 1999 through 2010 in the management of headache. We identified 9,362 visits for headache, representing an estimated 144 million visits during the study period. Nearly three-quarters of patients were female, and the mean age was approximately 46 years. Use of (computed tomography/ Magnetic resonance imaging) CT/MRI rose from 6.7% of visits in 1999-2000 to 13.9% in 2009-2010 (unadjusted p < 0.001), and referrals to other physicians increased from 6.9 % to 13.2% (p = 0.005). In contrast, clinician counseling declined from 23.5 % to 18.5% (p = 0.041). Use of preventive medications increased from 8.5 % to 15.9% (p = 0.001), while opioids/barbiturates remained unchanged, at approximately 18%. Adjusted trends were similar, as were results after stratifying by migraine versus non-migraine and acute versus chronic presentation. Primary care clinicians had lower odds of ordering CT/MRI (OR 0.56 [0.42, 0.74]). 3
2. Stovner L, Hagen K, Jensen R, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007;27(3):193-210. Review/Other-Dx N/A To assess and present all existing evidence of the world prevalence and burden of headache disorders. Globally, the percentages of the adult population with an active headache disorder are 46% for headache in general, 11% for migraine, 42% for tension-type headache and 3% for chronic daily headache. The study calculations indicate that the disability attributable to tension-type headache is larger worldwide than that due to migraine. On the World Health Organization's ranking of causes of disability, this would bring headache disorders into the 10 most disabling conditions for the two genders and into the five most disabling for women. 4
3. Stovner LJ, Andree C. Prevalence of headache in Europe: a review for the Eurolight project. J Headache Pain. 2010;11(4):289-299. Review/Other-Dx N/A To update studies on headache epidemiology as a preparation for the multinational European study on the prevalence and burden of headache and investigate the impact of different methodological issues on the results. More than 50% of adults indicate that they suffer from headache in general during the last year or less, but when asked specifically about tension-type headache, the prevalence was 60%. Migraine occurs in 15%, chronic headache in about 4% and possible medication overuse headache in 1%-2%. Cluster headache has a lifetime prevalence of 0.2%-0.3%. Most headaches are more prevalent in women. As to methodological issues, lifetime prevalence’s are in general higher than 1-year prevalence’s, but the exact time frame of headache (1 year, 6 or 3 months, or no time frame stated) seems to be of less importance. 4
4. Expert Panel on Neurologic Imaging:, Salmela MB, Mortazavi S, et al. ACR Appropriateness Criteria Cerebrovascular Disease. J. Am. Coll. Radiol.. 14(5S):S34-S61, 2017 May. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for cerebrovascular disease. No results stated in abstract. 4
5. Shetty VS, Reis MN, Aulino JM, et al. ACR Appropriateness Criteria Head Trauma. J. Am. Coll. Radiol.. 13(6):668-79, 2016 Jun. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for head trauma. No results stated in abstract. 4
6. Expert Panel on Neurologic Imaging:, Policeni B, Corey AS, et al. ACR Appropriateness Criteria Cranial Neuropathy. J. Am. Coll. Radiol.. 14(11S):S406-S420, 2017 Nov. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for cranial neuropathy. No results stated in abstract. 4
7. Expert Panel on Neurologic Imaging:, Kennedy TA, Corey AS, et al. ACR Appropriateness Criteria Orbits Vision and Visual Loss. Journal of the American College of Radiology. 15(5S):S116-S131, 2018 May.J. Am. Coll. Radiol.. 15(5S):S116-S131, 2018 May. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for orbits, vision and visual loss. No results stated in abstract. 4
8. Expert Panel on Neurologic Imaging:, Kirsch CFE, Bykowski J, et al. ACR Appropriateness Criteria Sinonasal Disease. J. Am. Coll. Radiol.. 14(11S):S550-S559, 2017 Nov. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for sinonasal disease. No results stated in abstract. 4
9. American College of Radiology. ACR Appropriateness Criteria®: Neuroendocrine Imaging. Available at: Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. No abstract available. 4
10. Olesen J.. International Classification of Headache Disorders. Lancet Neurology. 17(5):396-397, 2018 May.Lancet neurol.. 17(5):396-397, 2018 May. Review/Other-Dx N/A N/A No results stated in abstract 4
11. Cvetkovic VV, Strineka M, Knezevic-Pavlic M, Tumpic-Jakovic J, Lovrencic-Huzjan A. Analysis of headache management in emergency room. ACTA CLIN. CROAT.. 52(3):281-8, 2013 Sep. Observational-Dx 6225 patients To analyze the management of headache patients presenting to the emergency room (ER) at a university hospital in Zagreb. Among 6225 patients, 1385 (22.3%) complained of headache; there were 894 (64.5%) women and 491 (35.5%) men. Migraine with or without aura, tension-type headache or "cervicogenic headache" had 1004 (72.5%) patients (women 67.5% and men 32.5%); secondary headache had 381 (27.5%) patients: 89 (6.4%) stroke or intracranial hemorrhage, 33 (2.4%) primary tumor, 54 (3.9%) metastatic tumor, 200 (14.4%) head trauma with or without hemorrhage, and 5 (0.4%) had an infectious disease. Diagnostic procedure was performed in 413 (29.8%) patients: 314 (22.7%) underwent computerized tomography scan of the brain, 85 (6.1%) electroencephalography and 70 (5%) ultrasound examination. Nonsteroidal antiinflammatory drugs (NSAIDs) and diazepam were the most commonly prescribed medications, followed by fluids, simple analgesics and antiemetics, whereas opioids were prescribed to 3.0% of patients. Among patients with primary headaches, diagnostic procedure was performed in 235 (23.2%) patients, while 40 (4.0%) patients were hospitalized. 3
12. Eller M, Goadsby PJ. MRI in headache. [Review]. Expert rev. neurotherapeutics. 13(3):263-73, 2013 Mar. Review/Other-Dx N/A To review the magnetic resonance imaging (MRI) in headache. No results stated in abstract. 4
13. Nallasamy K, Singhi SC, Singhi P. Approach to headache in emergency department. Indian J Pediatr. 79(3):376-80, 2012 Mar. Review/Other-Dx N/A To evaluate the approach to headache in the emergency department. No results stated in abstract. 4
14. Silberstein SD, Lipton R, Goadsby PJ. Headache in Clinical Practice. In: olesen J, Tfelt-Hansen P, Welsch KMA, eds. The Headaches. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2000. Review/Other-Dx N/A Book chapter. No abstract available. 4
15. Mitsikostas DD. Nocebo in headache. Curr Opin Neurol 2016;29:331-6. Review/Other-Dx 20 patients To review nocebo in headache. Nocebo was higher in preventive treatments than in symptomatic ones. Among preventive migraine treatments botulin toxin A showed the lowest nocebo. Generally, the safer a drug was the less nocebo was induced. Nocebo was similar in trials for tension-type headache. To predict and prevent nocebo consequences a 4-item self-fulfilled questionnaire (Q-No) has been developed, with 72% specificity and 67% sensitivity. 4
16. Douglas AC, Wippold FJ 2nd, Broderick DF, et al. ACR Appropriateness Criteria Headache. J. Am. Coll. Radiol.. 11(7):657-67, 2014 Jul. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for headache. No results stated in abstract. 4
17. Lester MS, Liu BP. Imaging in the evaluation of headache. [Review]. Med Clin North Am. 97(2):243-65, 2013 Mar. Review/Other-Dx N/A To review Imaging in the evaluation of headache No results stated in abstract. 4
18. May A.. Pearls and pitfalls: neuroimaging in headache. [Review]. Cephalalgia. 33(8):554-65, 2013 Jun. Review/Other-Dx N/A To review the neuroimaging in headache. No results stated in abstract. 4
19. Gilbert JW, Johnson KM, Larkin GL, Moore CL. Atraumatic headache in US emergency departments: recent trends in CT/MRI utilisation and factors associated with severe intracranial pathology. Emerg Med J. 2011. Review/Other-Dx 15,062 patient records To estimate recent trends in CT/MRI utilization among patients seeking emergency care for atraumatic headache in the USA and to identify factors associated with a diagnosis of significant intracranial pathology in these patients. Between 1998 and 2008 the percentage of patients presenting to the ED with atraumatic headache who underwent imaging increased from 12.5% to 31.0% (P<0.01) while the prevalence of intracranial pathology among those visits decreased from 10.1% to 3.5% (P<0.05). The length of stay in the ED was 4.6 hours (95% CI: 4.4 to 4.8) for patients with headache who received imaging compared with 2.7 (95% CI: 2.6 to 2.9) for those who did not. Of 18 factors evaluated in patients with headache, 10 were associated with a significantly increased odds of an intracranial pathology diagnosis: age =50 years, arrival by ambulance, triage immediacy <15 minutes, systolic blood pressure =160 mm Hg or diastolic blood pressure =100 mm Hg and disturbance in sensation, vision, speech or motor function including neurological weakness. 4
20. Kernick DP, Ahmed F, Bahra A, et al. Imaging patients with suspected brain tumour: guidance for primary care. Br J Gen Pract. 2008;58(557):880-885. Review/Other-Dx N/A Review guidance for imaging of patients with suspected brain tumor. Study suggests management for three levels of risk of tumor: red flags >1%; orange flags 0.1-1%; and yellow flags <0.1% but above the background population rate of 0.01%. Clinical presentations are stratified into these 3 groups. Important secondary causes of headache where imaging is normal should not be overlooked, and normal investigation does not eliminate the need for follow-up or appropriate management of headache. 4
21. Kuruvilla DE, Lipton RB. Appropriate use of neuroimaging in headache. [Review]. Curr Pain Headache Rep. 19(6):17, 2015 Jun. Review/Other-Dx N/A To provide guidelines for the appropriate use of neuroimaging in headache. No results stated in abstract. 4
22. Loder E, Weizenbaum E, Frishberg B, Silberstein S, American Headache Society Choosing Wisely Task Force. Choosing wisely in headache medicine: the American Headache Society's list of five things physicians and patients should question. [Review]. Headache. 53(10):1651-9, 2013 Nov-Dec. Review/Other-Dx N/A To draw attention to tests and procedures associated with low-value care in headache medicine, the American Headache Society (AHS) joined the Choosing Wisely initiative of the American Board of Internal Medicine Foundation. No results stated in abstract. 4
23. Sempere AP, Porta-Etessam J, Medrano V, et al. Neuroimaging in the evaluation of patients with non-acute headache. Cephalalgia. 2005; 25(1):30-35. Observational-Dx 1,876 consecutive patients Prospective study to estimate the frequency of significant intracranial lesions in patients with headache and to determine the clinical variables helpful in identifying patients with intracranial lesions. Neuroimaging studies detected significant lesions in 22 patients [1.2%, 95% CI, 0.7, 1.8]. The rate of significant intracranial abnormalities in patients with headache and normal neurological examination was 0.9% (95% CI, 0.5, 1.4). The only clinical variable associated with a higher probability of intracranial abnormalities was neurological examination. The proportion of patients with headache and intracranial lesions is relatively small, but neither neurological examination nor the features in the clinical history permit authors to rule out such abnormalities. 3
24. Tsushima Y, Endo K. MR imaging in the evaluation of chronic or recurrent headache. Radiology. 2005;235(2):575-579. Observational-Dx 306 patients Retrospective chart review and literature review to determine the likelihood of MRI depicting an abnormality in patients with chronic headache and no neurologic abnormality. 169 patients (55.2%) were placed in the first group, 135 (44.1%) were placed in the second group, and two (0.7%) were placed in the third group because they had a clinically important abnormality at MRI. Neither contrast material enhancement (n=195) nor repeated MRI (n=23) contributed to the diagnosis. Literature review revealed 2 previous studies concerning unspecified headache (in addition to the current study), including a total of 1,036 MRI results and 22 (2.1%) clinically important results (upper 99.5% confidence bound, 3.4%). 12 studies of migraine headache were found, with a total of 790 MRI examinations. Excluding the 19 patients with complicated migraine, the 99.5% confidence bound of the frequency of clinically important abnormality at MRI was estimated as 0.68%. Clinically important infarctions were noted on MRIs in 5 (26.3%) of 19 patients with complicated migraine. MRI is an unrewarding technique in the evaluation of patients with chronic or recurrent headache and normal neurologic findings. 4
25. Perry JJ, Stiell IG, Sivilotti ML, et al. High risk clinical characteristics for subarachnoid haemorrhage in patients with acute headache: prospective cohort study. BMJ. 341:c5204, 2010 Oct 28.BMJ. 341:c5204, 2010 Oct 28. Observational-Dx 1999 patients To identify high risk clinical characteristics for subarachnoid haemorrhage in neurologically intact patients with headache. In the 1999 patients enrolled there were 130 cases of subarachnoid haemorrhage. Mean (range) age was 43.4 (16-93), 1207 (60.4%) were women, and 1546 (78.5%) reported that it was the worst headache of their life. Thirteen of the variables collected on history and three on examination were reliable and associated with subarachnoid haemorrhage. We used recursive partitioning with different combinations of these variables to create three clinical decisions rules. All had 100% (95% confidence interval 97.1% to 100.0%) sensitivity with specificities from 28.4% to 38.8%. Use of any one of these rules would have lowered rates of investigation (computed tomography, lumbar puncture, or both) from the current 82.9% to between 63.7% and 73.5%. 2
26. Bellolio MF, Hess EP, Gilani WI, et al. External validation of the Ottawa subarachnoid hemorrhage clinical decision rule in patients with acute headache. American Journal of Emergency Medicine. 33(2):244-9, 2015 Feb.Am J Emerg Med. 33(2):244-9, 2015 Feb. Review/Other-Dx 5409 records of patients To externally validate the Ottawa subarachnoid hemorrhage (OSAH) clinical decision rule. No results stated in abstract 4
27. Perry JJ, Stiell IG, Sivilotti ML, et al. Clinical decision rules to rule out subarachnoid hemorrhage for acute headache. JAMA. 310(12):1248-55, 2013 Sep 25. Observational-Dx 2131 patients To assess the accuracy, reliability, acceptability, and potential refinement (ie, to improve sensitivity or specificity) of these rules in a new cohort of patients with headache. Of the 2131 enrolled patients, 132 (6.2%) had subarachnoid hemorrhage. The decision rule including any of age 40 years or older, neck pain or stiffness, witnessed loss of consciousness, or onset during exertion had 98.5% (95% CI, 94.6%-99.6%) sensitivity and 27.5% (95% CI, 25.6%-29.5%) specificity for subarachnoid hemorrhage. Adding "thunderclap headache" (ie, instantly peaking pain) and "limited neck flexion on examination" resulted in the Ottawa subarachnoid hemorrhage (SAH) Rule, with 100% (95% CI, 97.2%-100.0%) sensitivity and 15.3% (95% CI, 13.8%-16.9%) specificity. 2
28. Mortimer AM, Bradley MD, Stoodley NG, Renowden SA. Thunderclap headache: diagnostic considerations and neuroimaging features. [Review]. Clin Radiol. 68(3):e101-13, 2013 Mar. Review/Other-Dx N/A To discuss the diagnostic considerations and neuroimaging features of thunderclap headache No results stated in abstract. 4
29. Schwedt TJ.. Thunderclap headaches: a focus on etiology and diagnostic evaluation. [Review]. Headache. 53(3):563-9, 2013 Mar. Review/Other-Dx N/A To review the focus on etiology and diagnostic evaluation. No results stated in abstract. 4
30. Mehdi A, Hajj-Ali RA. Reversible cerebral vasoconstriction syndrome: a comprehensive update. [Review]. Curr Pain Headache Rep. 18(9):443, 2014 Sep. Review/Other-Dx N/A To review the reversible cerebral vasoconstriction syndrome. No results stated in abstract. 4
31. Quon JS, Glikstein R, Lim CS, Schwarz BA. Computed tomography for non-traumatic headache in the emergency department and the impact of follow-up testing on altering the initial diagnosis. EMERG. RADIOL.. 22(5):521-5, 2015 Oct. Observational-Dx 1098 patients To determine the incidence of positive computed tomography (CT) findings in patients presenting to the emergency department (ED) with non-traumatic headache at our institution and (2) to examine follow-up exams, including lumbar puncture, non-enhanced CT, CT angiogram, CT venogram, and magnetic resonance imaging (MRI), to see how often the use of further testing changes the diagnosis. CT results were divided into three categories: P0, P1, and P2. Negative studies were graded as P0. Positive studies were subdivided into clinically insignificant or P1 and clinically significant or P2. Clinically significant was defined as requiring medical treatment. Subsequently, the electronic medical records and picture archiving and communication system (PACS) were reviewed to determine the incidence of follow-up exams, including lumbar puncture or imaging. The secondary tests were divided into the same P0, P1, and P2 categories. There were 254 positive studies: P1 clinically insignificant (27.1 %, 235/865) and P2 clinically significant (2.2 %, 19/865). Of 257 follow-up exams performed, the majority were lumbar punctures (36.0 %) or CT angiograms (29.5 %). In 19/257 exams or 7.4 %, the additional testing changed the clinically insignificant (P0/P1) diagnosis to a significant (P2) result. At our institution, there was a 2.2 % incidence of significant positive CT findings in patients presenting to the ED with non-traumatic headache. Follow-up testing was variable and resulted in a 7.4 % increase in the severity of diagnosis compared to the initial negative CT scan. 3
32. Carpenter CR, Hussain AM, Ward MJ, et al. Spontaneous Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Examination, Imaging, and Lumbar Puncture With an Exploration of Test Thresholds. [Review]. Academic Emergency Medicine. 23(9):963-1003, 2016 Sep.Acad Emerg Med. 23(9):963-1003, 2016 Sep. Meta-analysis 22 primary studies To perform a diagnostic accuracy systematic review and meta-analysis of history, physical examination, cerebrospinal fluid (CSF) tests, computed tomography (CT), and clinical decision rules for spontaneous SAH. A secondary objective was to delineate probability of disease thresholds for imaging and lumbar puncture (LP). A total of 5,022 publications were identified, of which 122 underwent full-text review; 22 studies were included (average SAH prevalence = 7.5%). Diagnostic studies differed in assessment of history and physical examination findings, CT technology, analytical techniques used to identify xanthochromia, and criterion standards for SAH. Study quality by QUADAS-2 was variable; however, most had a relatively low risk of biases. A history of neck pain (LR+ = 4.1; 95% confidence interval [CI] = 2.2 to 7.6) and neck stiffness on physical examination (LR+ = 6.6; 95% CI = 4.0 to 11.0) were the individual findings most strongly associated with SAH. Combinations of findings may rule out SAH, yet promising clinical decision rules await external validation. Noncontrast cranial CT within 6 hours of headache onset accurately ruled in (LR+ = 230; 95% CI = 6 to 8,700) and ruled out SAH (LR- = 0.01; 95% CI = 0 to 0.04); CT beyond 6 hours had a LR- of 0.07 (95% CI = 0.01 to 0.61). CSF analyses had lower diagnostic accuracy, whether using red blood cell (RBC) count or xanthochromia. At a threshold RBC count of 1,000 × 10(6) /L, the LR+ was 5.7 (95% CI = 1.4 to 23) and LR- was 0.21 (95% CI = 0.03 to 1.7). Using the pooled estimates of diagnostic accuracy and testing risks and benefits, we estimate that LP only benefits CT-negative patients when the pre-LP probability of SAH is on the order of 5%, which corresponds to a pre-CT probability greater than 20%. Good
33. Perry JJ, Stiell IG, Sivilotti ML, et al. Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study. BMJ. 343:d4277, 2011 Jul 18.BMJ. 343:d4277, 2011 Jul 18. Observational-Dx 3132 patients To measure the sensitivity of modern third generation computed tomography in emergency patients being evaluated for possible subarachnoid haemorrhage, especially when carried out within six hours of headache onset. Of the 3132 patients enrolled (mean age 45.1, 2571 (82.1%) with worst headache ever), 240 had subarachnoid haemorrhage (7.7%). The sensitivity of computed tomography overall for subarachnoid haemorrhage was 92.9% (95% confidence interval 89.0% to 95.5%), the specificity was 100% (99.9% to 100%), the negative predictive value was 99.4% (99.1% to 99.6%), and the positive predictive value was 100% (98.3% to 100%). For the 953 patients scanned within six hours of headache onset, all 121 patients with subarachnoid haemorrhage were identified by computed tomography, yielding a sensitivity of 100% (97.0% to 100.0%), specificity of 100% (99.5% to 100%), negative predictive value of 100% (99.5% to 100%), and positive predictive value of 100% (96.9% to 100%). 1
34. Blok KM, Rinkel GJ, Majoie CB, et al. CT within 6 hours of headache onset to rule out subarachnoid hemorrhage in nonacademic hospitals. Neurology. 84(19):1927-32, 2015 May 12. Observational-Dx 760 patients To investigate whether staff radiologists working in nonacademic hospitals can adequately rule out subarachnoid hemorrhage (SAH) on head computed tomography (CT) <6 hours after headache onset. Of 760 included patients, CSF analysis was considered positive for bilirubin in 52 patients (7%). Independent review of these patients' CTs identified one patient (1/52; 2%) with a perimesencephalic nonaneurysmal SAH. Negative predictive value for detection of subarachnoid blood by staff radiologists working in a nonacademic hospital was 99.9% (95% confidence interval 99.3%-100.0%). 2
35. Dubosh NM, Bellolio MF, Rabinstein AA, Edlow JA. Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis. [Review]. Stroke. 47(3):750-5, 2016 Mar. Meta-analysis 882 titles To determine the sensitivity of brain CT using modern scanners (16-slice technology or greater) when performed within 6 hours of headache onset to exclude SAH in neurologically intact patients. A total of 882 titles were reviewed and 5 articles met inclusion criteria, including an estimated 8907 patients. Thirteen had a missed SAH (incidence 1.46 per 1000) on brain CTs within 6 hours. Overall sensitivity of the CT was 0.987 (95% confidence intervals, 0.971-0.994) and specificity was 0.999 (95% confidence intervals, 0.993-1.0). The pooled likelihood ratio of a negative CT was 0.010 (95% confidence intervals, 0.003-0.034). M
36. Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med. 2006;354(4):387-396. Review/Other-Dx N/A To review aneurysmal SAH. No results stated in abstract. 4
37. da Rocha AJ, da Silva CJ, Gama HP, et al. Comparison of magnetic resonance imaging sequences with computed tomography to detect low-grade subarachnoid hemorrhage: Role of fluid-attenuated inversion recovery sequence. Journal of Computer Assisted Tomography. 30(2):295-303, 2006 Mar-Apr.J Comput Assist Tomogr. 30(2):295-303, 2006 Mar-Apr. Observational-Dx 45 patients To compare computed tomography (CT) with magnetic resonance imaging (MRI) for the presumptive diagnosis and localization of acute and subacute low-grade subarachnoid hemorrhage (SAH). Three of 45 patients had normal CT and MRI scans, and SAH was excluded by lumbar puncture. We demonstrated SAH on CT scans in 28 of 42 (66.6%) patients, T2* sequences in 15 of 42 (35.7%) patients, and FLAIR sequences in 42 of 42 (100%) patients. Fluid-attenuated inversion recovery sequences were superior to CT in 16 of the 26 evaluated regions. 2
38. Mohamed M, Heasly DC, Yagmurlu B, Yousem DM. Fluid-attenuated inversion recovery MR imaging and subarachnoid hemorrhage: not a panacea.[Erratum appears in AJNR Am J Neuroradiol. 2004 May;25(5):904 Note: Heaseley, D Cressler [corrected to Heasly, D Cressler]], [Erratum appears in AJNR Am J Neuroradiol. 2008 Nov;29(10):E107]. Ajnr: American Journal of Neuroradiology. 25(4):545-50, 2004 Apr.AJNR Am J Neuroradiol. 25(4):545-50, 2004 Apr. Review/Other-Dx 12 patients To determine how often FLAIR MR imaging findings are positive for SAH in cases with negative CT findings and positive lumbar puncture results. For all 12 control cases without SAH, the FLAIR MR imaging findings were interpreted correctly. Of the 12 cases that had positive lumbar puncture results but false-negative CT findings for SAH, FLAIR MR imaging findings were true-positive in only two cases and were false-negative in 10. One of the two true-positive cases had the highest concentration of RBC in the series (365 k/cc), and the other had the second highest value of RBC (65 k/cc). 4
39. Kirby S, Purdy RA. Headaches and brain tumors. [Review]. Neurol Clin. 32(2):423-32, 2014 May. Review/Other-Dx N/A To review the Headaches and brain tumors. No results stated in abstract. 4
40. Montella S, Ranieri A, Marchese M, De Simone R. Primary stabbing headache: a new dural sinus stenosis-associated primary headache?. Neurol Sci. 34 Suppl 1:S157-9, 2013 May. Observational-Dx 50 subjects To evaluate the association of abnormalities in cerebral venous circulation with Primary stabbing headache (PSH). All MRV revealed significant unilateral or bilateral sinus stenosis. Mean age at PSH onset was 35.3 +/- 18.9 years (range 11-67 years). Duration of attacks ranged 1-3 s. Median daily frequency of attacks was 4 (range 2-20); median number of days per month with PSH presentation was 14 (range 4-30). Six patients described attacks in temporal or parietal areas, one at the top of the head, and one in the occipital area. Only one patient had isolated PSH; all the others were diagnosed also with migraine without aura. Seven out of eight patients responded to indomethacin 75 mg/die, and one to topiramate 100 mg/die. Interestingly, both drugs share with acetazolamide a cerebral spinal fluid (CSF) pressure lowering effect. Our findings indicate that PSH is associated with central sinus stenosis and suggest that an undiagnosed ss-IHWOP might be involved in PSH pathogenesis. 3
41. Friedman DI, Jacobson DM. Diagnostic criteria for idiopathic intracranial hypertension. Neurology. 2002;59(10):1492-1495. Review/Other-Dx N/A To report an updated diagnostic criteria for IIH that may be used for routine patient management and for research purposes. No results stated in abstract. 4
42. Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 81(13):1159-65, 2013 Sep 24. Review/Other-Dx N/A To provide diagnostic criteria for pseudotumor cerebri syndrome in adults and children. No results stated in abstract. 4
43. Sidhom Y, Mansour M, Messelmani M, et al. Cerebral venous thrombosis: clinical features, risk factors, and long-term outcome in a Tunisian cohort. J STROKE CEREBROVASC DIS. 23(6):1291-5, 2014 Jul. Observational-Dx 41 patients To characterize clinical presentation, predisposing factors, neuroimaging findings, and outcomes of the disease in the Tunisian population. This study included 41 patients with cerebral venous thrombosis (CVT). Mean age was 41.24 years, predominantly women (68%). The mode of onset was acute in 10 patients (24%), subacute in 26 (64%), and chronic in 5 (12%). The most common presenting features were headache, observed in 83% of the patients, followed by seizures, focal motor deficits, papilledema, and mental status changes. Lateral (56%) and superior longitudinal (51%) sinuses were the most commonly involved. Multiple sinuses were involved in 46% of cases. Nineteen patients (46%) had a D-dimer level more than 500 ng/mL. Major causes of CVT were thrombophilia (56%), either genetic or acquired, obstetric and gynecological (50%), and septic (34%). Outcome was favorable in 83% of patients. At the end of follow-up, 32 patients (78%) had complete recovery (modified Rankin Scale [mRs] score 0-1), 2 (5%) had partial recovery (mRs score 2), and 4 (10%) were dependent (mRs score 3-5). One patient (2.5%) had a recurrent sinus thrombosis. 3
44. Sparaco M, Feleppa M, Bigal ME. Cerebral Venous Thrombosis and Headache--A Case-Series. Headache. 55(6):806-14, 2015 Jun. Observational-Dx 25 adult patients To report a case-series of Cerebral Venous Thrombosis (CVT), focusing on headache characteristics. Headache was reported by 23 out of 25 (92%) of participants, being by far the most frequent symptom. It was the sole manifestation in nearly one third of the patients (8/25, 32.0%). Headache was typically severe (19/23, 82.6%) and throbbing (16/23, 69.5%), with sudden onset (13/23, 56.5%) and non-remitting (20/23, 86.9%) characteristics. The sinus most frequently involved was the transverse sinus (24/25, 96.0%), either alone or in association with other sinuses. 2
45. Timoteo A, Inacio N, Machado S, Pinto AA, Parreira E. Headache as the sole presentation of cerebral venous thrombosis: a prospective study. J HEADACHE PAIN. 13(6):487-90, 2012 Aug. Observational-Dx 30 patients To study the characteristics of headache as the sole presentation of  cerebral venous thrombosis (CVT), namely if there was a typical pattern of headache or if there was an association between its features and the sinuses involved and extension of CVT. There was no association between the characteristics of headache and extension of CVT. Time from onset to diagnosis was significantly delayed in these patients presenting only with headache. In our series, 40 % of patients presented only with headache. There was no uniform pattern of headache apart from being bilateral. There was a significant delay of diagnosis in these patients. Some characteristics of headache should raise the suspicion of CVT: recent persistent headache, thunderclap headache or pain worsening with straining, sleep/lying down or Valsalva maneuvers even in the absence of papilloedema or focal signs. 3
46. Avsenik J, Oblak JP, Popovic KS. Non-contrast computed tomography in the diagnosis of cerebral venous sinus thrombosis. Radiology & Oncology. 50(3):263-8, 2016 Sep 01.RADIOL. ONCOL.. 50(3):263-8, 2016 Sep 01. Observational-Dx 53 patients To investigate the sensitivity and specificity of non-contrast computed tomography (NCCT) in the diagnosis of cerebral venous sinus thrombosis (CVST). CVST was confirmed in 13 patients. Sensitivity and specificity of NCCT for overall presence of CVST were 100% and 83%, respectively, with Kappa value of 0.72 (a good agreement between observers). The attenuation values between CVST patients and control group were significantly different (73.4 ± 14.12 HU vs. 58.1 ± 7.58 HU; p = 0.000). The ROC analysis showed an area under the curve (AUC) of 0.916 (95% CI, 0.827 - 1.00) and an optimal cutoff value of 64 HU, leading to a sensitivity of 85% and specificity of 87%. 2
47. Saposnik G, Barinagarrementeria F, Brown RD, Jr., et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(4):1158-1192. Review/Other-Tx N/A To provide an overview of cerebral venous sinus thrombosis and to provide recommendations for its diagnosis, management, and treatment. No results stated in abstract 4
48. Wetzel SG, Kirsch E, Stock KW, Kolbe M, Kaim A, Radue EW. Cerebral veins: comparative study of CT venography with intraarterial digital subtraction angiography. Ajnr: American Journal of Neuroradiology. 20(2):249-55, 1999 Feb.AJNR Am J Neuroradiol. 20(2):249-55, 1999 Feb. Observational-Dx 25 patients To compare the reliability of CT venography with intraarterial digital subtraction angiography (DSA) in imaging cerebral venous anatomy and pathology Using DSA as the standard of reference, MPR images had an overall sensitivity of 95% (specificity, 19%) and MIP images a sensitivity of 80% (specificity, 44%) in depicting the cerebral venous anatomy. On the basis of an intraobserver consensus including DSA, MPR, and MIP images (415 vessels present), the sensitivity/specificity was 95%/91% for MPR, 90%/100% for DSA, and 79%/91% for MIP images. MPR images were superior to DSA images in showing the cavernous sinus, the inferior sagittal sinus, and the basal vein of Rosenthal. Venous occlusive diseases were correctly recognized on both MPR and MIP images. Only DSA images provided reliable information of invasion of a sinus by an adjacent meningioma. 2
49. Gaikwad AB, Mudalgi BA, Patankar KB, Patil JK, Ghongade DV. Diagnostic role of 64-slice multidetector row CT scan and CT venogram in cases of cerebral venous thrombosis. Emergency Radiology. 15(5):325-33, 2008 Sep.EMERG. RADIOL.. 15(5):325-33, 2008 Sep. Observational-Dx 53 patients To evaluate the role of CT scan as the primary modality of imaging in suspected cases of cerebral venous thrombosis (CVT). Out of the total 33 patients, 20 patients were detected to have thrombosis of one or more of the cerebral venous sinuses or veins, at the concluding consensus reading. MDCTA together with NCCT could identify thrombosis in all of the 20 patients, i.e., 100% sensitivity and specificity. Sixty-four-slice MDCTA together with NCCT provided 100% sensitivity and specificity for the identification of CVT. It can be considered as a cost-effective and widely available, primary imaging modality in emergency situations. 2
50. Khandelwal N, Agarwal A, Kochhar R, et al. Comparison of CT venography with MR venography in cerebral sinovenous thrombosis. AJR Am J Roentgenol. 2006;187(6):1637-1643. Observational-Dx 50 patients To compare cerebral CT venography with MR venography and determine the reliability of CT venography in the diagnosis of cerebral sinovenous thrombosis. Of these 50 patients, 30 patients were diagnosed as having cerebral sinovenous thrombosis on both CT venography and MR venography. The total numbers of sinuses involved were 81 and 77 (CT venography and MR venography). When MR venography was used as the gold standard, CT venography was found to have both a sensitivity and a specificity of 75%–100%, depending on the sinus and vein involved. 2
51. Chang RO, Marshall BK, Yahyavi N, et al. Neuroimaging Features of Idiopathic Intracranial Hypertension Persist After Resolution of Papilloedema. Neuro-Ophthalmology. 40(4):165-170, 2016 Aug.NEURO-OPHTHALMOLOGY. 40(4):165-170, 2016 Aug. Review/Other-Dx 18 patients To review three groups (six per group) of patients with idiopathic intracranial hypertension(IIH ) who had received orbital imaging within 4 weeks of fundoscopic examination:(1) IIH patients without active papilloedema, (2) IIH patients with active papilloedema, and (3) patients with no history of IIH or papilloedema Neuroimaging features were compared by using the Kruskal-Wallis one-way analysis of variance. Measurements of sellar and optic nerve configuration showed a statistical trend with papilloedema status. For the control group versus the active papilloedema group, the values were 0.0597 and 0.0621, respectively. For the control group versus the resolved papilloedema group, the values were 0.0485 and 0.0512, respectively. However, globe and sellar p values for the resolved papilloedema group versus the active papilloedema group were 1.000 and 0.6023, respectively, and not significant. Sellar and globe configuration suggest that a statistical trend for persistence after papilloedema has resolved and intracranial pressure (ICP) has normalised. Careful clinical correlation and fundus examination are essential because some of these neuroimaging features can be seen in normal patients and those with resolved IIH, and their presence on MRI may not necessarily indicate active disease or elevated ICP. 4
52. Maralani PJ, Hassanlou M, Torres C, et al. Accuracy of brain imaging in the diagnosis of idiopathic intracranial hypertension. Clin Radiol. 67(7):656-63, 2012 Jul. Observational-Dx 43 patients; 43 control subjects To investigate the accuracy of individual and combinations of signs on brain magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) in the diagnosis of idiopathic intracranial hypertension (IIH). Partially empty sella (specificity 95.3%, p < 0.0001), flattening of the posterior globes (specificity 100%, p < 0.0001), and CSS <4 (specificity 100%, p < 0.0001) were highly specific for IIH. The presence of one sign, or any combination, significantly increased the odds of a diagnosis of IIH (LR+ 18.5 to 46, p < 0.0001). Their absence, however, did not rule out IIH 2
53. Morris PP, Black DF, Port J, Campeau N. Transverse Sinus Stenosis Is the Most Sensitive MR Imaging Correlate of Idiopathic Intracranial Hypertension. Ajnr: American Journal of Neuroradiology. 38(3):471-477, 2017 Mar.AJNR Am J Neuroradiol. 38(3):471-477, 2017 Mar. Observational-Dx 63 patients To demonstrate that transverse sinus stenosis could be identified on conventional MR imaging, and this identification would allow improved diagnostic sensitivity to this condition. Transverse sinus stenosis was identified bilaterally on MRV in 94% of patients with idiopathic intracranial hypertension and in 3% of controls. On coronal T1 postgadolinium MR images, transverse sinus stenosis was identified in 83% of patients with idiopathic intracranial hypertension and 7% of controls. Previously described MR imaging signs of intracranial hypertension were identified in 8%-61% of patients with idiopathic intracranial hypertension. Correlation among the 3 modes of evaluation was highly significant (P < .0001). 2
54. Detsky ME, McDonald DR, Baerlocher MO, Tomlinson GA, McCrory DC, Booth CM. Does this patient with headache have a migraine or need neuroimaging?. [Review] [67 refs]. JAMA. 296(10):1274-83, 2006 Sep 13.JAMA. 296(10):1274-83, 2006 Sep 13. Meta-analysis 5470 patients To determine the usefulness of the history and physical examination that distinguish patients with migraine from those with other headache types and that identify those patients who should undergo neuroimaging. Four studies of screening questions for migraine (n = 1745 patients) and 11 neuroimaging studies (n = 3725 patients) met inclusion criteria. All 4 of the migraine studies illustrated high sensitivity and specificity if 3 or 4 criteria were met. The best predictors can be summarized by the mnemonic POUNDing (Pulsating, duration of 4-72 hOurs, Unilateral, Nausea, Disabling). If 4 of the 5 criteria are met, the likelihood ratio (LR) for definite or possible migraine is 24 (95% confidence interval [CI], 1.5-388); if 3 are met, the LR is 3.5 (95% CI, 1.3-9.2), and if 2 or fewer are met, the LR is 0.41 (95% CI, 0.32-0.52). For the neuroimaging question, several clinical features were found on pooled analysis to predict the presence of a serious intracranial abnormality: cluster-type headache (LR, 10.7; 95% CI, 2.2-52); abnormal findings on neurologic examination (LR, 5.3; 95% CI, 2.4-12); undefined headache (ie, not cluster-, migraine-, or tension-type) (LR, 3.8; 95% CI, 2.0-7.1); headache with aura (LR, 3.2; 95% CI, 1.6-6.6); headache aggravated by exertion or a valsalva-like maneuver (LR, 2.3; 95% CI, 1.4-3.8); and headache with vomiting (LR, 1.8; 95% CI, 1.2-2.6). No clinical features were useful in ruling out significant pathologic conditions. Good
55. Holle D, Obermann M. The role of neuroimaging in the diagnosis of headache disorders. Therapeutic Advances in Neurological Disorders. 6(6):369-74, 2013 Nov.Ther. adv. neurol. disord.. 6(6):369-74, 2013 Nov. Review/Other-Dx 3026 scans of patients To review the role of neuroimaging in the diagnosis of headache disorders. No results stated in abstract. 4
56. M S, Lamont AC, Alias NA, Win MN. Red flags in patients presenting with headache: clinical indications for neuroimaging. British Journal of Radiology. 76(908):532-5, 2003 Aug.Br J Radiol. 76(908):532-5, 2003 Aug. Observational-Dx 111 patients To evaluate clinical features in patients with headache using neuroimaging as a screening tool for intracranial pathology. A retrospective study of 111 patients was performed and the outcomes were divided into positive and negative. Abnormal neuroimaging was present in 39 patients. Results were analysed using the Logistic Regression model. Sensitivity and specificity of red flags were analysed to establish the cut-off point to predict abnormal neuroimaging and a receiver operating characteristic (ROC) curve plotted to show the sensitivity of the diagnostic test. Three red flag features proved to be statistically significant with the p-value of less than 0.05 on both univariate and multivariate analysis. These were: paralysis; papilloedema; and "drowsiness, confusion, memory impairment and loss of consciousness". In addition, if three or more red flags from the list were present, this showed strong indication of abnormal neuroimaging, from cut-off point of ROC curve (area under the curve =0.76). 3
57. Sandrini G, Friberg L, Coppola G, et al. Neurophysiological tests and neuroimaging procedures in non-acute headache (2nd edition). Eur J Neurol. 2011;18(3):373-381. Review/Other-Dx N/A An update of the 2004 European Federation of Neurological Societies guidelines and recommendations for the use of neurophysiological tools and neuroimaging procedures in non-acute headache (first edition). Although many of the examinations described in the present guidelines are of little or no value in the clinical setting, most of the tools, including thermal pain thresholds and transcranial magnetic stimulation, have considerable potential for differential diagnostic evaluation as well as for the further exploration of headache pathophysiology and the effects of pharmacological treatment. 4
58. Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med. 343(2):100-5, 2000 Jul 13. Observational-Dx 1st phase – 520 consecutive patients; 2nd phase – 909 consecutive patients Prospective study to derive and validate a set of clinical criteria that could be used to identify patients with MHI in whom CT could be forgone. The study was conducted in two phases at a large, inner-city, level 1 trauma center. Of the 520 patients in the first phase, 36 (6.9%) had positive scans. All patients with positive CT scans had one or more of 7 findings: headache, vomiting, an age over 60 years, drug or alcohol intoxication, deficits in short-term memory, physical evidence of trauma above the clavicles, and seizure. Among the 909 patients in the second phase, 57 (6.3%) had positive scans. In this group of patients, the sensitivity of the 7 findings combined was 100% (95% CI, 95% to 100%). All patients with positive CT scans had at least one of the findings. For the evaluation of patients with MHI, the use of CT can be safely limited to those who have certain clinical findings. 3
59. Stiell IG, Wells GA, Vandemheen K, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet. 357(9266):1391-6, 2001 May 05. Observational-Dx 3,121 consecutive patients Prospective cohort multicenter study to develop a highly sensitive clinical decision rule for use of CT in patients with minor head injuries. A CT head rule was derived which consists of 5 high-risk factors (failure to reach GCS (G of 15 within 2 h, suspected open skull fracture, any sign of basal skull fracture, vomiting >2 episodes, or age >65 years) and two additional medium-risk factors (amnesia before impact >30 min and dangerous mechanism of injury). The high-risk factors were 100% sensitive (95% CI, 92%-100%) for predicting need for neurological intervention, and would require only 32% of patients to undergo CT. The medium-risk factors were 98.4% sensitive (95% CI, 96%-99%) and 49.6% specific for predicting clinically important brain injury, and would require only 54% of patients to undergo CT. 3
60. Xu H, Pi H, Ma L, Su X, Wang J. Incidence of Headache After Traumatic Brain Injury in China: A Large Prospective Study. World Neurosurg. 88:289-96, 2016 Apr. Observational-Dx 543 patients To evaluate the incidence of headache after traumatic brain injury (TBI) and investigate risk factors and functional outcome in a large tertiary center with a high caseload. Of our 543 patients (82% men, 18% women), 62% were injured in motor vehicle collisions and 27% in falls. Most patients (97%) were considered to have mild TBI. Follow-up rates at 3, 6, and 12 months were 91%, 75%, and 61%, respectively. Only 12% of patients reported pre-TBI headaches, whereas 58% of respondents reported headache at 3 months follow-up, 54% at 6 months follow-up, and 49% at 1 year follow-up. No statistically significant correlations between age, sex, or TBI severity and posttraumatic headaches were observed. 2
61. Alvarez R, Ramon C, Pascual J. Clues in the differential diagnosis of primary vs secondary cough, exercise, and sexual headaches. [Review]. Headache. 54(9):1560-2, 2014 Oct. Review/Other-Dx N/A To review the differential diagnosis of primary vs secondary cough, exercise, and sexual headaches. No results stated in abstract. 4
62. Donnet A, Valade D, Houdart E, et al. Primary cough headache, primary exertional headache, and primary headache associated with sexual activity: a clinical and radiological study. Neuroradiology. 55(3):297-305, 2013 Feb. Observational-Dx 36 patients To describe clinical features of primary cough headache, primary exertional headache, and primary headache associated with sexual activity and to evaluate potential association with abnormalities in the cerebral or cervical venous circulation. In all primary headache groups, headaches were most frequently diffuse, severe, or very severe. Headache duration was significantly shorter in patients with cough headache (median 6.5 versus 20 and 60 min). An exploitable magnetic resonance venogram was obtained for 36 patients. Stenosis was detected in none of the control group, but in 5/7 patients with primary cough headache group, 2/10 patients with primary exertion headache, and 12/19 patients with primary headache associated with sexual activity. The frequency of stenosis was significantly different from the control group in the primary cough headache and primary headache associated with sexual activity groups. 2
63. Pascual J, Gonzalez-Mandly A, Martin R, Oterino A. Headaches precipitated by cough, prolonged exercise or sexual activity: a prospective etiological and clinical study. Journal of Headache & Pain. 9(5):259-66, 2008 Oct.J HEADACHE PAIN. 9(5):259-66, 2008 Oct. Observational-Dx 6,412 patients To delimitate characteristics, etiology, response to treatment and neuroradiological diagnostic protocol of those patients who consult to a general Neurological Department because of provoked headache. A total of 6,412 patients consulted due to headache during the 10 years of the study. The number of patients who had consulted due to any of these headaches is 97 (1.5% of all headaches). Diagnostic distribution was as follows: 68 patients (70.1%) consulted due to cough headache, 11 (11.3%) due to exertional headache and 18 (18.6%) due to sexual headache. A total of 28 patients (41.2%) out of 68 were diagnosed of primary cough headache, while the remaining 40 (58.8%) had secondary cough headache, always due to structural lesions in the posterior fossa, which in most cases was a Chiari type I malformation. In seven patients, cough headache was precipitated by treatment with angiotensin-converting enzyme inhibitors. As compared to the primary variety, secondary cough headache began earlier (average 40 vs. 60 years old), was located posteriorly, lasted longer (5 years vs. 11 months), was associated with posterior fossa symptoms/signs and did not respond to indomethacin. All those patients showed difficulties in the cerebrospinal fluid circulation in the foramen magnum region in the dynamic MRI study and preoperative plateau waves, which disappeared after posterior fossa reconstruction. The mean age at onset for primary headaches provoked by physical exercise and sexual activity began at the same age (40 years old), shared clinical characteristics (bilateral, pulsating) and responded to beta-blockers. Contrary to cough headache, secondary cases are rare and the most frequent etiology was subarachnoid bleeding. In conclusion, these conditions account for a low proportion of headache consultations. These data show the total separation between cough headache versus headache due to physical exercise and sexual activity, confirm that these two latter headaches are clinical variants of the same entity and illustrate the clinical differences between the primary and secondary provoked headaches. 2
64. Yeh YC, Fuh JL, Chen SP, Wang SJ. Clinical features, imaging findings and outcomes of headache associated with sexual activity. Cephalalgia. 30(11):1329-35, 2010 Nov.Cephalalgia. 30(11):1329-35, 2010 Nov. Observational-Dx 30 patients To study the clinical profiles, imaging findings and outcomes and field test the diagnostic criteria proposed by the International Classification of Headache Disorders, 2nd edition (ICHD-II) in patients with headache associated with sexual activity (HSA). Twenty patients (67%) had secondary causes, including one subarachnoid hemorrhage, one basilar artery dissection, and 18 cases reversible cerebral vasoconstriction syndrome (RCVS). Ten patients (33%) had primary HSA. The demographics, headache profiles, drug response and clinical course were similar between primary and secondary HSA. Compared to prior studies done in Western societies, our patients had similar clinical features but with a higher ratio of females (50%) and a higher frequency of chronic course (39%). 2
65. Mokri B, Ahlskog JE, Luetmer PH. Chorea as a manifestation of spontaneous CSF leak. Neurology. 2006;67(8):1490-1491. Review/Other-Dx 1 patient The study examined a 59-year-old man presented with orthostatic headaches, memory complaints, pronounced choreiform movements, and related hyperkinetic dysarthria and titubations. Head MRI findings were suggestive of CSF leak. CSF pressure was low. CT myelography documented CSF leak at the cervicothoracic junction. Targeted epidural blood patch led to resolution of symptoms, including complete disappearance of choreiform movements. 4
66. Schievink WI, Maya MM. Quadriplegia and cerebellar hemorrhage in spontaneous intracranial hypotension. Neurology. 2006;66(11):1777-1778. Review/Other-Dx N/A No abstract available. No abstract available. 4
67. Syed NA, Mirza FA, Pabaney AH, Rameez-ul-Hassan. Pathophysiology and management of spontaneous intracranial hypotension--a review. [Review]. JPMA J Pak Med Assoc. 62(1):51-5, 2012 Jan. Review/Other-Dx N/A To review the Pathophysiology and management of spontaneous intracranial hypotension. No results stated in abstract. 4
68. Schievink WI, Maya MM, Louy C, Moser FG, Tourje J. Diagnostic criteria for spontaneous spinal CSF leaks and intracranial hypotension. AJNR Am J Neuroradiol. 2008;29(5):853-856. Observational-Dx 107 consecutive patients A new set of diagnostic criteria for spontaneous spinal CSF leaks and SIH encompassing its varied clinical and radiographic manifestations is presented. The intent of these criteria is to present a diagnostic scheme that can be used to more reliably diagnose spontaneous spinal CSF leaks and intracranial hypotension. The diagnosis was confirmed in 94 patients, with use of criterion A in 78 patients, criterion B in 11 patients, and criterion C in 5 patients. 4
69. Nye BL, Ward TN. Clinic and Emergency Room Evaluation and Testing of Headache. [Review]. Headache. 55(9):1301-8, 2015 Oct. Review/Other-Dx N/A To review the evaluation of patients in both settings with mention of evaluation in the pediatric and pregnant patient population. No results stated in abstract. 4
70. Ramchandren S, Cross BJ, Liebeskind DS. Emergent headaches during pregnancy: correlation between neurologic examination and neuroimaging. AJNR Am J Neuroradiol. 2007;28(6):1085-1087. Review/Other-Dx 63 patients Retrospective review to examine demographic and clinical features that are predictive of intracranial pathologic lesions on neuroimaging studies in pregnant women with emergent headaches. 43% of subjects had abnormal neurologic examination findings. Emergent neuroimaging studies may reveal an underlying headache etiology in 27% of pregnant women. Odds of having intracranial pathologic lesions on neuroimaging were 2.7 times higher in patients with abnormal results on neurologic examination (P=.085). 4
71. Azizyan A, Miller JM, Azzam RI, et al. Spontaneous retroclival hematoma in pituitary apoplexy: case series. J Neurosurg. 123(3):808-12, 2015 Sep. Review/Other-Dx 18 cases To review the cases of spontaneous retroclival hematoma in pituitary apoplexy. Eighteen patients (13 men and 5 women; mean age 54 years) were identified with presenting symptoms of sudden onset of headache and ophthalmoplegia, and laboratory findings consistent with pituitary apoplexy. Ten of these patients (8 men and 2 women; mean age 55 years) had imaging findings consistent with retroclival hematoma. 4
72. Jho DH, Biller BM, Agarwalla PK, Swearingen B. Pituitary apoplexy: large surgical series with grading system. World Neurosurg. 82(5):781-90, 2014 Nov. Observational-Dx 109 cases To present a retrospective series of 109 consecutive cases of pituitary apoplexy from a single institution from 1992 to 2012 and develop acomprehensive classification system to analyze outcome. Most of the patients in this series presented clinically with "classic" pituitary apoplexy (97%), had magnetic resonance imaging for evaluation (99%), underwent transsphenoidal surgery as their primary treatment (93%), and were found to have pituitary adenomas on histopathology (90%). We categorized patients into 5 grades based on clinical presentation. Tumor volume, cavernous sinus involvement, suprasellar extension, and need for ongoing endocrine replacement correlated with grade. Long-term endocrine replacement at follow-up was required in 62%-68% of patients with a higher grade compared with 0-23% of patients with a lower grade. Higher grade patients tended to undergo earlier surgery after symptom onset. Symptoms resolved or improved with treatment in 92%-100% of patients across all grades with good general outcomes for visual deficits and ocular motility problems, validating management decisions overall. 3
73. Kim WJ, Shin HY, Kim YC, Moon JY. Clinical Association Between Brain MRI Findings With Epidural Blood Patch in Spontaneous Intracranial Hypotension. J Neurosurg Anesthesiol. 28(2):147-52, 2016 Apr. Observational-Dx 185 patients To compare brain magnetic resonance imaging (MRI) findings and clinical variables between conservative management group and epidural blood patch (EBP) group. The incidence of abnormalities of brain MRI findings did not show significant differences between conservative treatment and EBP. However, the proportion of patients with severe pain was higher in patients who underwent EBP. In multivariate regression analysis, the incidence of positive brain MRI finding(s) for spontaneous intracranial hypotension (SIH) increased in patients with older age, higher weight, and an absence in nausea/vomiting. EBP procedure was effective in both younger and elderly patients. 3
74. Robbins MS, Farmakidis C, Dayal AK, Lipton RB. Acute headache diagnosis in pregnant women: a hospital-based study. Neurology. 85(12):1024-30, 2015 Sep 22. Observational-Dx 140 patients To characterize demographic and clinical features in pregnant women presenting with acute headache, and to identify clinical features associated with secondary headache. The 140 women had a mean age of 29 +/- 6.4 years and often presented in the third trimester (56.4%). Diagnoses were divided into primary (65.0%) and secondary (35.0%) disorders. The most common primary headache disorder was migraine (91.2%) and secondary headache disorders were hypertensive disorders (51.0%). The groups were similar in demographics, gestational ages, and most headache features. In univariate analysis, secondary headaches were associated with a lack of headache history (36.7% vs 13.2%, p = 0.0012), seizures (12.2% vs 0.0%, p = 0.0015), elevated blood pressure (55.1% vs 8.8%, p < 0.0001), fever (8.2% vs 0.0%, p = 0.014), and an abnormal neurologic examination (34.7% vs 16.5%, p = 0.014). In multivariate logistic regression, elevated blood pressure (odds ratio [OR] 17.0, 95% confidence interval [CI] 4.2-56.0) and a lack of headache history (OR 4.9, 95% CI 1.7-14.5) had an increased association with secondary headache, while psychiatric comorbidity (OR 0.13, 95% CI 0.021-0.78) and phonophobia (OR 0.29, 95% CI 0.09-0.91) had a reduced association with secondary headache. 3
75. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators.. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 388(10053):1545-1602, 2016 10 08.Lancet. 388(10053):1545-1602, 2016 10 08. Meta-analysis 85 causes To  estimate the  incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated and standardised analytical procedures. We generated 9·3 billion estimates from the various combinations of prevalence, incidence, and YLDs for causes, sequelae, and impairments by age, sex, geography, and year. In 2015, two causes had acute incidences in excess of 1 billion: upper respiratory infections (17·2 billion, 95% uncertainty interval [UI] 15·4-19·2 billion) and diarrhoeal diseases (2·39 billion, 2·30-2·50 billion). Eight causes of chronic disease and injury each affected more than 10% of the world's population in 2015: permanent caries, tension-type headache, iron-deficiency anaemia, age-related and other hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that affected the greatest number of people in 2015 was anaemia, with 2·36 billion (2·35-2·37 billion) individuals affected. The second and third leading impairments by number of individuals affected were hearing loss and vision loss, respectively. Between 2005 and 2015, there was little change in the leading causes of years lived with disability (YLDs) on a global basis. NCDs accounted for 18 of the leading 20 causes of age-standardised YLDs on a global scale. Where rates were decreasing, the rate of decrease for YLDs was slower than that of years of life lost (YLLs) for nearly every cause included in our analysis. For low SDI geographies, Group 1 causes typically accounted for 20-30% of total disability, largely attributable to nutritional deficiencies, malaria, neglected tropical diseases, HIV/AIDS, and tuberculosis. Lower back and neck pain was the leading global cause of disability in 2015 in most countries. The leading cause was sense organ disorders in 22 countries in Asia and Africa and one in central Latin America; diabetes in four countries in Oceania; HIV/AIDS in three southern sub-Saharan African countries; collective violence and legal intervention in two north African and Middle Eastern countries; iron-deficiency anaemia in Somalia and Venezuela; depression in Uganda; onchoceriasis in Liberia; and other neglected tropical diseases in the Democratic Republic of the Congo. Good
76. Stewart WF, Wood C, Reed ML, Roy J, Lipton RB. Cumulative lifetime migraine incidence in women and men. Cephalalgia. 2008;28(11):1170-1178. Observational-Dx 120,000 US households To estimate lifetime sex and age-specific incidence of migraine. Data are from the American Migraine Prevalence and Prevention study, a mailed survey sent to 120,000 U.S. households. Cumulative incidence was 43% in women and 18% in men. Median age of onset was 25 years among women and 24 years among men. Onset in 50% of cases occurred before age 25 and in 75% before age 35 years. 4/10 women and 2/10 men will contract migraine in their lifetime, most before age 35 years. The incidence estimates from this analysis are consistent with those reported in previous longitudinal studies. 4
77. Becker LA, Green LA, Beaufait D, Kirk J, Froom J, Freeman WL. Use of CT scans for the investigation of headache: a report from ASPN, Part 1. J Fam Pract. 1993; 37(2):129-134. Review/Other-Dx 349 CT scans To provide information about the reasons for ordering CT scans and the results obtained. Clinicians in 58 practices ordered 349 CT scans. Only 52 patients (15%) had abnormalities noted on neurological examination. Most CT scans were ordered because the clinician believed that a tumor (49%) or an SAH (9%) might be present. Fifty-nine (17%) were ordered because of patient expectation or medicolegal concerns. Of the 293 reports reviewed, 14 indicated that a tumor, an SAH, or an SDH was present. Two of the 14 (14%) were false positives. Forty-four (15%) of the reports noted incidental findings of questionable significance. 4
78. Goldstein JN, Camargo CA Jr, Pelletier AJ, Edlow JA. Headache in United States emergency departments: demographics, work-up and frequency of pathological diagnoses. Cephalalgia. 26(6):684-90, 2006 Jun.Cephalalgia. 26(6):684-90, 2006 Jun. Review/Other-Dx 5198 visits To examine headache work-ups and diagnoses across the USA of a representative sample of adult ED visits (the National Hospital Ambulatory Medical Care Survey) for the years 1992-2001 Of the 14% of patients who underwent neuroimaging, 5.5% received a pathological diagnosis. Of the 2% of patients who underwent lumbar puncture, 11% received a pathological diagnosis. On multivariable analysis, a decreased rate of imaging was noted for patients without private insurance [odds ratio (OR) 0.61, confidence interval (CI) 0.44, 0.86] and for those presenting off-hours (OR 0.55, CI 0.39, 0.77). Patients over 50 were more likely to receive a pathological diagnosis (OR 3.3, CI 1.2, 9.3). In conclusion, clinicians should ensure that appropriate work-ups are performed regardless of presentation time or insurance status, and be vigilant in the evaluation of older patients. 4
79. Katz M.. The Cost-Effective Evaluation of Uncomplicated Headache. [Review]. Med Clin North Am. 100(5):1009-17, 2016 Sep. Review/Other-Dx N/A To determine the Cost-Effective Evaluation of Uncomplicated Headache. N/A 4
80. Lebedeva ER, Gurary NM, Gilev DV, Olesen J. Prospective testing of ICHD-3 beta diagnostic criteria for migraine with aura and migraine with typical aura in patients with transient ischemic attacks. Cephalalgia. 38(3):561-567, 2018 Mar.Cephalalgia. 38(3):561-567, 2018 Mar. Observational-Dx 120 patients To field test ICHD-3 beta diagnostic criteria for migraine with aura and migraine with typical aura in patients with transient ischemic attacks. No results stated in abstract 2
81. Frishberg BM. The utility of neuroimaging in the evaluation of headache in patients with normal neurologic examinations. Neurology. 1994;44(7):1191-1197. Review/Other-Dx N/A To review literature to determine usefulness of neuroimaging in evaluating headache patients with normal neurologic examinations. CT or MRI may be indicated in patients with atypical headache patterns, a history of seizures or focal neurologic signs. Insufficient evidence to define the role of CT and MRI in the evaluation of patients with headaches that are inconsistent with migraine. 4
82. Dinia L, Bonzano L, Albano B, et al. White matter lesions progression in migraine with aura: a clinical and MRI longitudinal study. Journal of Neuroimaging. 23(1):47-52, 2013 Jan. Observational-Dx 41 patients To evaluate longitudinal changes in white matter lesions (WMLs) in migraineurs with aura, by magnetic resonance imaging (MRI), and to correlate WMLs modifications with patients' clinical characteristics. WMLs were present in 26 subjects (63.4%) at baseline MRI. At follow-up a total of 8 patients had new WMLs (19.5%). There was a significant correlation between aura duration and number of new WMLs, and between the number of migraine attacks with aura and new WMLs. 2
83. Gaist D, Garde E, Blaabjerg M, et al. Migraine with aura and risk of silent brain infarcts and white matter hyperintensities: an MRI study. Brain. 139(Pt 7):2015-23, 2016 07. Observational-Dx 172 cases (34 co-twins and 139 control subjects) To investigate an association between migraine with aura and risk of silent brain infarcts and white matter hyper intensities  in a population-based sample of female twins Comparisons were based on 172 cases, 34 co-twins, and 139 control subjects. Compared with control subjects, cases did not differ with regard to frequency of silent brain infarcts (four cases versus one control), periventricular white matter hyperintensity scores [adjusted mean difference (95% confidence interval): -0.1 (-0.5 to 0.2)] or deep white matter hyperintensity scores [adjusted mean difference (95% confidence interval): 0.1 (-0.8 to 1.1)] assessed by Scheltens' scale. Cases had a slightly higher total white matter hyperintensity volume compared with controls [adjusted mean difference (95% confidence interval): 0.17 (-0.08 to 0.41) cm(3)] and a similar difference was present in analyses restricted to twin pairs discordant for migraine with aura [adjusted mean difference 0.21 (-0.20 to 0.63)], but these differences did not reach statistical significance. We found no evidence of an association between silent brain infarcts, white matter hyperintensities, and migraine with aura. 1
84. Honningsvag LM, Hagen K, Haberg A, Stovner LJ, Linde M. Intracranial abnormalities and headache: A population-based imaging study (HUNT MRI). Cephalalgia. 36(2):113-21, 2016 Feb. Observational-Dx 864 patients To evaluate the relationship between intracranial abnormalities and headache among middle-aged adults in the general population. Intracranial abnormalities were more common in headache sufferers than in headache-free individuals (29% vs. 22%, respectively; p = 0.041). Adjusted multivariate analyses revealed that those with tension-type headache had higher odds of having minor abnormalities (odds ratio, 2.13; 95% confidence interval = 1.18-3.85). This association disappeared when those with only white matter hyperintensities were removed from the analysis. 3
85. Kruit MC, Launer LJ, Ferrari MD, van Buchem MA. Infarcts in the posterior circulation territory in migraine. The population-based MRI CAMERA study. Brain. 128(Pt 9):2068-77, 2005 Sep.Brain. 128(Pt 9):2068-77, 2005 Sep. Experimental-Dx 435 patients To describe the clinical and neuroimaging characteristics of migraine cases with and without aura and controls with PC lesions. In total, 39 PC infarct-like lesions represented the majority (65%) of all 60 identified brain infarct-like lesions in the study sample (n = 435 subjects with and without migraine). Most lesions (n = 33) were located in the cerebellum, often multiple, and were round or oval-shaped, with a mean size of 7 mm. The majority (88%) of infratentorial infarct-like lesions had a vascular border zone location in the cerebellum. Prevalence of these border zone lesions differed between controls (0.7%), cases with migraine without aura (2.2%) and cases with migraine with aura (7.5%). Besides higher age, cardiovascular risk factors were not moreprevalent in cases with migraine with PC lesions. Presence of these lesions was not associated with supratentorial brain changes, such as white matter lesions. The combination of vascular distribution, deep border zone location, shape, size and imaging characteristics on MRI makes it likely that the lesions have an infarct origin. Previous investigators attributed cases of similar ‘very small’ cerebellar infarcts in non-migraine patients to a number of different infarct mechanisms. The relevance and likelihood of the aetiological options are placed in the context of known migraine pathophysiology. In addition, the specific involvement of the cerebellum in migraine is discussed. The results suggest that a combination of (possibly migraine attack-related) hypoperfusion and embolism is the likeliest mechanism for PC infarction in migraine, and not atherosclerosis or small-vessel disease. 2
86. Vijiaratnam N, Barber D, Lim KZ, et al. Migraine: Does aura require investigation?. Clinical Neurology & Neurosurgery. 148:110-4, 2016 Sep.Clin Neurol Neurosurg. 148:110-4, 2016 Sep. Review/Other-Dx 505 patients To analyse the demographics of migraine presentations to our hospital and the yield of imaging in our centre to help guide future approaches to these patients. We found patients with aura were more likely to have hypercholesterolemia (12% vs 7%, p=0.05). Patients with aura were more likely to be evaluated with imaging (CT brain (70% vs 41% p<0.0001) and MRI brain (44% vs 17% p<0.0001)). The patients investigated with imaging had no clinically significant findings. 21% of patients with aura were investigated with carotid Doppler studies. Only 1 patient had an abnormal result. Patients with white matter hyperintensities were older (51 vs 39 years; p<0.0001) and were more likely to have Hypertension (29% vs 14% p=0.019), Hypercholesterolemia (29% vs 11% p=0.003) and T2DM (16% vs 4% p=0.011). 4
87. Clarke CE, Edwards J, Nicholl DJ, Sivaguru A. Imaging results in a consecutive series of 530 new patients in the Birmingham Headache Service. Journal of Neurology. 257(8):1274-8, 2010 Aug.J Neurol. 257(8):1274-8, 2010 Aug. Review/Other-Dx 530 patients To review imaging results in a consecutive series of 530 new patients in the Birmingham Headache Service. Five hundred thirty (14.5%) underwent imaging with large differences in the proportion referred by each consultant. There were more insignificant abnormalities on MRI (46%) than CT (28%). There were 11 significantly abnormal results (2.1% of those imaged). Significant abnormalities were found in patients diagnosed with migraine in 1.2% and in 0.9% of those with tension-type headache. Significant abnormalities in those suspected to have an intracranial abnormality occurred in 5.5%. This supports the practice of selecting patients with suspicious findings for imaging, rather than imaging all patients. 4
88. Paemeleire K, Proot P, De Keyzer K, Achten E, Crevits L. Magnetic resonance angiography of the circle of Willis in migraine patients. Clinical Neurology & Neurosurgery. 107(4):301-5, 2005 Jun.Clin Neurol Neurosurg. 107(4):301-5, 2005 Jun. Review/Other-Dx 244 patients To analyze the Magnetic resonance angiography of the circle of Willis in migraine patients. No results stated in abstract. 4
89. Levy MJ, Matharu MS, Meeran K, Powell M, Goadsby PJ. The clinical characteristics of headache in patients with pituitary tumours. Brain. 2005;128(Pt 8):1921-1930. Review/Other-Dx 84 patients To describe prospectively the phenotypic characteristics of pituitiary tumor related to headache in a large series of patients and to correlate the headache presentations with the tumor biology. The patients presented with chronic (46%) and episodic (30%) migraine, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing; 5%), cluster headache (4%), hemicrania continua (1%) and primary stabbing headache (27%). It was not possible to classify the headache according to International Headache Society diagnostic criteria in six cases (7%). Cavernous sinus invasion was present in the minority of presentations (21%), but was present in 2/3 patients with cluster headache. short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing-like headache was only seen in patients with acromegaly and prolactinoma. Hypophysectomy improved headache in 49% and exacerbated headache in 15% of cases. Somatostatin analogues improved acromegaly-associated headache in 64% of cases, although rebound headache was described in three patients. Dopamine agonists improved headache in 25% and exacerbated headache in 21% of cases. 4
90. Williams M, Bazina R, Tan L, Rice H, Broadley SA. Microvascular decompression of the trigeminal nerve in the treatment of SUNCT and SUNA. Journal of Neurology, Neurosurgery & Psychiatry. 81(9):992-6, 2010 Sep.J Neurol Neurosurg Psychiatry. 81(9):992-6, 2010 Sep. Review/Other-Dx 9 patients To discuss  the nine cases of SUNCT/SUNA that failed medical treatment and had an aberrant arterial loop either in contact with or compressing the appropriate trigeminal nerve demonstrated on MRI. Immediate and complete relief of SUNCT and SUNA symptoms occurred in 6/9 (67%) cases. This was sustained for a follow-up period of 9-32 months (mean 22.2). In 3/9 (33%) cases, there was no benefit. Ipsilateral hearing loss was observed in one case. 4
91. Favier I, van Vliet JA, Roon KI, et al. Trigeminal autonomic cephalgias due to structural lesions: a review of 31 cases. Arch Neurol. 2007;64(1):25-31. Review/Other-Dx 31 Cases To review the literature and 4 new cases of a trigeminal autonomic cephalgias or trigeminal autonomic cephalgias-like syndrome associated with a structural lesion in which symptoms resolved after treatment of the lesion. Even typical trigeminal autonomic cephalgiass can be caused by an underlying lesion. Clinical warning signs and symptoms are relatively rare. 4
92. Head Imaging Guidelines. Review/Other-Dx N/A No abstract available. No abstract available. 4
93. de Coo IF, Wilbrink LA, Haan J. Symptomatic Trigeminal Autonomic Cephalalgias. [Review]. Curr Pain Headache Rep. 19(8):39, 2015 Aug. Review/Other-Dx 19 cases To review the recent insights in symptomatic Trigeminal autonomic cephalalgias (TACs) by comparing and categorizing newly published cases. No results stated in abstract 4
94. Bigal ME, Lipton RB. The prognosis of migraine. [Review] [55 refs]. Curr Opin Neurol. 21(3):301-8, 2008 Jun. Review/Other-Dx N/A To review the prognosis of migraine. No results stated in abstract. 4
95. Silberstein S, Loder E, Diamond S, et al. Probable migraine in the United States: results of the American Migraine Prevalence and Prevention (AMPP) study. Cephalalgia. 27(3):220-9, 2007 Mar. Review/Other-Dx 162 576 individuals To describe the epidemiology, medical recognition and patterns of treatment for Probable migraine (PM) in the united state of American (USA); to compare the patterns of preventive PM treatment in the population with expert panel guidelines for preventive treatment. Our sample consisted of 162 576 individuals aged > or = 12 years. The 1-year period prevalence of PM was 4.5% (3.9% in men and 5.1% in women). In women and men, prevalence was higher in middle life, between the ages of 30 and 59 years. The prevalence of PM was significantly higher in African-Americans than in Whites (female 7.4% vs. 4.8%; male 4.8% vs. 3.7%) and inversely related to household income. During their headaches, most (48.2%) had at least some impairment, while 22.1% were severely disabled. The vast majority (97%) of PM sufferers used acute treatments, although 71% usually treated with over-the-counter medication. Most PM sufferers (52.8%) never used a migraine-preventive treatment and only 7.9% were currently using preventive medication. According to the expert panel guidelines, prevention should be offered (16.9%) or considered (11.5%) for 28.4% of the PM sufferers in the survey. 4
96. Hale N, Paauw DS. Diagnosis and treatment of headache in the ambulatory care setting: a review of classic presentations and new considerations in diagnosis and management. [Review]. Med Clin North Am. 98(3):505-27, 2014 May. Review/Other-Dx N/A To review theclassic presentations and new considerations in diagnosis and management. No results stated in the abstract 4
97. Choosing Wisely® An initiative of the ABIM Foundation. American College of Radiology. Ten Things Physicians and Patients Should Question.  Available at: Review/Other-Dx N/A A review of the Ten Things Physicians and Patients Should Question. No results were stated in the abstract. 4
98. Morris Z, Whiteley WN, Longstreth WT Jr, et al. Incidental findings on brain magnetic resonance imaging: systematic review and meta-analysis. [Review] [30 refs]. BMJ. 339:b3016, 2009 Aug 17.BMJ. 339:b3016, 2009 Aug 17. Meta-analysis 16 studies To quantify the prevalence of incidental findings on magnetic resonance imaging (MRI) of the brain. In 16 studies, 135 of 19 559 people had neoplastic incidental brain findings (prevalence 0.70%, 95% confidence interval 0.47% to 0.98%), and prevalence increased with age (chi(2) for linear trend, P=0.003). In 15 studies, 375 of 15 559 people had non-neoplastic incidental brain findings (prevalence 2.0%, 1.1% to 3.1%, excluding white matter hyperintensities, silent infarcts, and microbleeds). The number of asymptomatic people needed to scan to detect any incidental brain finding was 37. The prevalence of incidental brain findings was higher in studies using high resolution MRI sequences than in those using standard resolution sequences (4.3% v 1.7%, P<0.001). The prevalence of neoplastic incidental brain findings increased with age. Good
99. Weber F, Knopf H. Incidental findings in magnetic resonance imaging of the brains of healthy young men. Journal of the Neurological Sciences. 240(1-2):81-4, 2006 Jan 15.J Neurol Sci. 240(1-2):81-4, 2006 Jan 15. Observational-Dx 2,536 patients To determine the frequency of serious intracranial abnormalities in a healthy young male population. The authors report a variety of morphological abnormalities in the brains of a large population of healthy young males, providing data on disease prevalence. Arachnoid cysts were found in 1.7% (95% CI 1.2 to 2.3%), vascular abnormalities in 0.51% (95% CI 0.29 to 0.9%), and intracranial tumors in 0.47% (95% CI 0.26 to 0.85%) of the applicants. No cerebral aneurysms were found. 2
100. Miller DG, Vakkalanka P, Moubarek ML, Lee S, Mohr NM. Reduced Computed Tomography Use in the Emergency Department Evaluation of Headache Was Not Followed by Increased Death or Missed Diagnosis. The Western Journal of Emergency Medicine. 19(2):319-326, 2018 Mar.West J Emerg Med. 19(2):319-326, 2018 Mar. Review/Other-Dx 582 separate index ED visits To review the the electronic medical records of the patients sampled during a quality improvement effort in which the aforementioned decrease in head computed tomography (HCT) use had been observed. Of the 582 separate index ED visits sampled, we observed a total of nine deaths and 10 missed intracranial diagnoses. There was no difference in the proportion of death (p = 0.337) or missed intracranial diagnosis (p = 0.312) observed after a 9.6% reduction in HCT use. Among patients who subsequently had visits for headache or brain imaging, we found that these patients were significantly more likely to have not had a HCT done during the index ED visit (59.2% vs. 49.6% (p = 0.031) and 37.1% vs. 26% (p = 0.006), respectively). 4
101. Forsyth PA, Posner JB. Headaches in patients with brain tumors: a study of 111 patients. Neurology. 1993;43(9):1678-1683. Observational-Dx 111 patients To characterize brain tumor headache in patients with primary or metastatic brain tumors identified by CT or MRI. Headaches were present in 48%, equally for primary and metastatic brain tumors. Headaches were similar to tension-type in 77%, migraine-type in 9%, and other types in 14%. The typical headache was bifrontal but worse ipsilaterally, and was the worst symptom in only 45% of patients. 4
102. Forde G, Duarte RA, Rosen N. Managing Chronic Headache Disorders. [Review]. Medical Clinics of North America. 100(1):117-41, 2016 Jan.Med Clin North Am. 100(1):117-41, 2016 Jan. Review/Other-Dx N/A To review the management of chronic disorders. No results stated in abstract. 4
103. Choosing Wisely® An initiative of the ABIM Foundation. Clinician Lists.  Available at: Review/Other-Dx N/A To examine the nitiative of the ABIM Foundation. N/A 4
104. American College of Radiology. ACR–SPR Practice Parameter for the Safe and Optimal Performance of Fetal Magnetic Resonance Imaging (MRI). Available at: Review/Other-Dx N/A To promote safe and optimal performance of fetal magnetic resonance imaging (MRI). No abstract available. 4
105. American College of Radiology. ACR-SPR Practice Parameter for Imaging Pregnant or Potentially Pregnant Adolescents and Women with Ionizing Radiation. Available at: Review/Other-Dx N/A To assist practitioners in providing appropriate radiologic care for pregnant or potentially pregnant adolescents and women by describing specific training, skills and techniques. No abstract available. 4
106. American College of Radiology. ACR-ACOG-AIUM-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetrical Ultrasound. Available at: Review/Other-Dx N/A To promote the safe and effective use of diagnostic and therapeutic radiology by describing the key elements of standard ultrasound examinations in the first, second, and third trimesters of pregnancy. No abstract available. 4
107. American College of Radiology. Manual on Contrast Media. Available at: Review/Other-Dx N/A To assist radiologists in recognizing and managing risks associated with the use of contrast media. No abstract available. 4
108. Expert Panel on MR Safety, Kanal E, Barkovich AJ, et al. ACR guidance document on MR safe practices: 2013. J Magn Reson Imaging. 37(3):501-30, 2013 Mar. Review/Other-Dx N/A To help guide MR practitioners regarding MR safety issues and provide a basis for them to develop and implement their own MR policies and practices. No abstract available. 4
109. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4