Image courtesy of Barco
December 29, 2014 — Recent guidelines seeking to reduce the use of neuroimaging tests for patients with headaches run the risk of missing or delaying the diagnosis of brain tumors, according to an article in Neurosurgery.
Neurosurgeon Dr. Ammar H. Hawasli and colleagues of Washington University School of Medicine, St. Louis, gave their perspective on recent guidelines suggesting limited use of CT scans and other neuroimaging tests for patients with headache.
Reducing the use of neuroimaging for patients with headaches has been one focus of recent initiatives seeking to limit the use of unnecessary and costly medical tests.
Several groups have proposed guidelines to limit the neuroimaging for headaches. For example, the "Choosing Wisely" guidelines developed by the American College of Radiology and Consumer Reports, include the recommendation, "Do not do imaging for uncomplicated headaches"—that is, most common types of stable headache, without any neurological abnormalities. A series of 95 patients with a confirmed diagnosis of a brain tumor at their department were analyzed. Nearly half of the patients had a combination of symptoms, such as seizures, cognitive and speech dysfunction or other neurological abnormalities. However, about one-fourth had isolated headaches, no symptoms or nonspecific symptoms.
In 11 patients, a headache was the only symptom of a brain tumor. Four of these patients had new-onset headaches that would have qualified them for neuroimaging under recently proposed guidelines.
The remaining seven patients had a migraine or other types of headache for which imaging may not have been performed under the proposed "Choosing Wisely" guidelines. Depending on which set of recent recommendations had been followed neuroimaging would have been delayed or never performed in 3-7 percent of patients with brain tumors.
That could have important implications for patient outcomes, as early diagnosis of brain tumors enables prompt treatment and a wider range of surgical options.
Authors of the study highlight the need for further research to develop "accurate and viable" guidelines on neuroimaging for headaches.
For more information: www.journals.lww.com/neurosurgery/pages/default.aspx
October 20, 2025 
