Purpose :

Computerized tomographic (CT) examination of patients presenting with atypical or severe headache has been essential until the last couple of years in order to rule out subarachnoid hemorrhage (SAH). However, there are studies suggesting that recently developed magnetic resonance imaging (MRI) sequences can provide more detailed information about hemorrhage and calcification compared to CT. In this study, we included SWI (Susceptibility Weighted Imaging) sequences in imaging protocol of patients in whom MRI examination was thought to be essential after presenting with acute headache. Our purpose was to determine if there is asymmetric increased signal intensity in hemispheric cortical venous network, in other words venous engorgement, in patients presenting with acute headache.

Material and method:

27 cases, who were admitted to the emergency department due to headache within the last one year and subsequently diagnosed with migraine, 23 cases, who were diagnosed with non-migraine headache (sinusitis, non-specific) and 19 healthy subjects were included in this study. Standard sequences of the cases were evaluated by a single reader in different time periods and hemispheric cortical venous signal intensities were compared that were defined subjectively as right or left dominant or symmetric.

Results:

No statistically significant difference was found between the three different reading findings. When the average of three measurements are taken into consideration, venous system of both hemispheres in migraine group was symmetric in 19.75% of the cases whereas there was right hemispheric venous engorgement in 44.45% and left hemispheric venous engorgement in 35.80% of the cases. The measured values in non-migraine headache group were 85.50%, 13.00% and 1.50%; and in the control group without headache the measured values were 75.50%, 3.50% and 21.00%, respectively.

Conclusion:

Compared to the control group and non-migraine headache group, there was increased signal intensity in hemispheric cortical venous network that was interpreted as right or left-sided asymmetric venous engorgement in patients who underwent emergency cranial MRI due to headache and in whom clinical findings were consistent with the migraine headache. It seems currently feasible to estimate the type of headache with the addition of this sequence into the imaging protocol of patients presenting with acute headache.

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