Brain CT scan findings among patients with headache without other neurological features in selected hospitals in Kampala, Uganda.

Abstract

Background: Headache refers to the pain in the head or face which sometimes includes the upper neck. Pain sensitive structures in the head and face include the skin, bone, structures in the eyes, ears, nose, and mouth. Headache is classified as primary when it is without any organic cause or secondary if there is an established cause. Most of the patients suffering from primary headache can be managed with primary care and do not require neuroimaging in most of the cases. However, many patients undergo evaluation with computed tomography (CT) which imparts high radiation with a risk of radiation induced cancers in the future. There is therefore a need to justify CT examinations in such patients. MRI is the preferred modality of neuroimaging especially for headache. However, in many African countries, it is costly and not readily available. In Uganda, there are only 5 MRI centers which are all situated in Kampala to serve a population of over 40 million. Brain CT scan findings among patients with headache and normal neurological findings has not been documented in our environment. This study therefore seeks to bridge this paucity of knowledge. Objective: To determine the prevalence and brain CT scan findings among patients presenting with headache and no other neurological features in selected hospitals in Kampala. Methods: This was a descriptive cross-sectional study in which patients who had headache with no other neurological features were recruited at the radiology departments in selected hospitals within Kampala where they presented with request forms for brain CT scan. Questionnaires were used to obtain the patient biodata and other clinical information. Results: The results show that the prevalence of abnormal CT findings in patients presenting with headache with no neurological features is 34.7%. The most prevalent pathology found was; sinusitis (12.1%). The main brain pathology found was brain atrophy (9.2%). The other brain pathologies found included; 1 intraventricular cyst, 2 berry aneurysms, 1 cavum septum pellucidum and verge, and 1 patient with a transverse Sinus stenosis. The primary types of headache were; migraine (50.3%), tension (10.4%) and cluster (4.6%) respectively. The results further showed that having issues within your relationships was not significantly associated with abnormal CT findings (p-value 0.053). There was no significant association found between abnormal CT and red flags in headaches. The following were found to have a significant association between headache and abnormal CT findings- HIV/AID medication (p-value 0.022), having cancer (p-value 0.006), being hypertensive p-value 0.023, and lastly alcohol consumption (p-value 0.028). Conclusion: Majority (65.3%) of the patients with headache with no neurological features had normal head CT scans. Chronic sinusitis and hypertrophied turbinates were the most common abnormal CT scan findings.