According to a study published in the journal Neurosurgery, headache could at times be the only symptom of brain tumour, recommending CT scans and other neuroimaging tests for people with headache for early diagnosis of the disease.

According to the researchers, those who ignore headache are at a risk of delaying or missing the diagnosis. Event specialists following recent guidelines that suggest limiting the use of CT scans and other tests for patients with headaches risk their patients who might have brain tumour. Dr Ammar H Hawasli and colleagues at Washington University School of Medicine, St Louis, emphasised that the intention of not using scans and imaging tests is agreeable but the guidelines are inconsistent with the neurosurgeon’s experience with patients having brain tumour. Since there are a lot of patients visits with headache as a common complaint, focusing on the issue is important.

Migraine and other reasons for headache are diagnosed in the doctor’s office, without the need for any special tests. But neurosurgeons, with their experience with patients having brain tumours, can differentiate between types of headaches. According to Hawasli and coauthors, patients with brain tumours may suffer from isolated headaches in the absence of other neurological symptoms and signs.

To reach the conclusion, the authors analysed 95 patients with a confirmed diagnosis of brain tumour.

Nearly half the patients showed a combination of symptoms, such as seizures, cognitive and speech dysfunction, or other neurological abnormalities. However, about one-fourth had isolated headaches without any other symptoms.

It was found that about 11 patients had only headache as the symptom of brain tumour. Four of them had new-onset headaches that would have qualified them for neuroimaging under recently proposed guidelines. The remaining seven patients had migraine or other types of headache for which imaging may not have been performed under the proposed ‘Choosing Wisely’ guidelines.

Following the analysis, the researchers noted that based on the set of recent recommendations that were followed; neuroimaging or scans would have been delayed or never performed in at least three to seven per cent of patients who were diagnosed with brain tumours.

The research has important implications for patient outcomes, as early diagnosis of brain tumours can facilitate early treatment with a wider range of surgical options. ‘We support careful and sensible use of neuroimaging in which physicians exercise excellent clinical judgement to reduce waste in the medical system,’ researchers said.

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