Recent guidelines seeking to reduce the use of CT scans and other neuroimaging tests for patients with headaches run the risk of missing or delaying the diagnosis of brain tumours, researchers said.
"Although the intentions are laudable, these guidelines are inconsistent with the neurosurgeon's experience with patients with brain tumour," Dr Ammar H Hawasli and colleagues at Washington University School of Medicine, St Louis, said.
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.
The issue is an important one, as headaches are a common reason for physician visits.
In most cases, migraine and other types of headache can be diagnosed in the doctor's office, without any special tests.
Several groups have proposed guidelines to limit the neuroimaging for headache.
However, from their experience in treating patients with brain tumours, Hawasli and coauthors raise concerns about this recommendation.
"Specifically, patients with brain tumours may present with isolated headaches in the absence of other neurological symptoms and signs," they said.
They analyzed a series of 95 patients with a confirmed diagnosis of brain tumour at their department.     Nearly half of 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, headache was the only symptom of brain tumour. Four of these patients 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.
Depending on which set of recent recommendations had been followed, neuroimaging would have been delayed or never performed in three to seven per cent of patients with brain tumours, researchers said.
That could have important implications for patient outcomes, as early diagnosis of brain tumours enables prompt treatment and 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.     

The research was published in the journal Neurosurgery.

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