Computed tomography head findings among adults with chronic headache in relation to other neurological symptoms at MTRH, Eldoret – Kenya.

Abstract

Background: Headache is one of the commonest presenting complaints among patients in both emergency departments and general outpatient clinics and affects all people regardless of age, gender and race. Chronic headache is defined as headache occurring for 15 or more days in a month for at least three months. Computed Tomography (CT) has been the modality of choice for investigating patients with chronic headache because it is quick, accessible, easily available and relatively affordable. Majority of patients with chronic headache only, usually have normal CT examination unlike those with other additional neurological symptoms Objective: To describe the pattern of CT scan head findings among adults presenting with chronic headache and describe the difference in CT findings in patients with chronic headache only and those with chronic headache and other neurological symptoms at MTRH, Eldoret. Kenya Methods: This was a cross sectional study done at CT scan room in the Department of Radiology and Imaging at MTRH, Eldoret between September 2017 and August 2018.Ninety six (96) consecutive patients with chronic headache irrespective of presence or absence of other neurological symptoms were done head CT scan according to MTRH protocol. Upon obtaining an informed consent, Sociodemographic data and clinical symptoms were captured using a questionnaire while CT findings were recorded on standardised reporting form. All the images were reviewed by principal investigator and verified by two consultant radiologists. Analysis was done using STATA/MP Version 13. Categorical variables were summarized as frequencies and percentages while continuous variables as mean, smedian and standard deviation. Association between categorical variables were assessed using Pearson’s chi-square. A p - values less than 0.05 was considered statistically significant. Results were presented using graphs, tables and charts. Results: The age range of the studied patients was 18 – 80 years with a mean of 41.1 ±15.9 years and female preponderance (54.2%). In general, majority of the patients with chronic headache were found to have normal head CT scan (n= 52, 54.2%). For the abnormal CT scan head findings, intracranial (n=21, 47.7%) and extracranial (n=23, 52.3%) lesions were nearly equal in distribution. Vascular lesions (33% - ischaemic infarct and vascular haemorrhage) and brain atrophy (29%) were the two common intracranial finding. Sinusitis (82.6%) was the commonest extracranial finding with maxillary preponderance (69.6%). Thirty (90.9%) out the 33 cases who presented with additional neurological symptoms had positive yield on CT scan compared to 14(22.2%) out of 63 cases who presented with chronic headache only (χ2=41.15, p <0.001). Conclusion: (1) Sinusitis was the commonest finding with maxillary sinus being the most affected (69.6%). (2)There was a higher abnormal yield on head CT when a patient presented with chronic headache in addition to other neurological symptoms compared to those presenting with chronic headache only. Recommendation: Higher index of suspicion of abnormal findings on CT scan of the head advised when a patient presents with chronic headache plus other neurological symptoms.