When to get a CATSCAN

    
      Re: When to get a CATSCAN
    


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Posted by CCF Neuro MD on August 12, 1997 at 23:13:16:

In Reply to: When to get a CATSCAN posted by Deb on July 16, 1997 at 18:54:27:

: HI
  I started getting severe headaches about 10 months ago - I now call them Migraines. They're always on  one-side of my head, cause severe pain, for 1-3 days every week (and  reek havoc on my  activities and relationships) .
  I've seen my M.D. who just wants to give me medication then sent me to an opthamologist, a physiotherapist who referred me to a masseuse who I can't afford, I tried chiropractic but The whole idea seemed insane and my migraines were getting worse going there.
  I don't know why I get these migraines- I have a feeling it has to do with my nervous system - I have IBS (irritable bowel syndrome) and can get rather (involuntarily) anxious about stuff, have suffered depression.
  However, my question  is: Is a CAT SCAN normal protocol  when discerning whether these are, in fact, Migraines. My MD did no tests, when I told her I get these frequent, outrageous pains in the side of my head her response was -must be Migraines, here's some medication.  So are migraines a symptom of anything that may be descovered in a CatScan ?  
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Dear Deb:
You raise an interesting question : When is a CT scan appropriate in a patient with headaches? Since the test is harmless (except in pregnancy), it is always nicer to know (than not to know) that everything is fine inside the head. The limiting factor, however, is the limited availability of resources. The majority of individuals suffer from headaches some time in their lifetime, and 5-8% of men and 12-16% of women suffer from migraines. If all of these individuals were to be scanned, the country would be bankrupt.
The positive yield of the CT scan in chronic headaches is low. The chance of finding relevant pathology in all chronic headaches is about 2-3%. The number for migraines is less than 1%. Meaning, more than 99% of CT scans in migraine patients are normal. The key lies in identifying cases with an extremely low likelihood of having an underlying brain/intracranial problem, and choosing not to scan these. Features such as long duration or chronicity of headaches, childhood onset, and typical characteristics of migraine are helpful in this regard. Contrarily, there are some clinical