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Case Reports in Otolaryngology
Volume 2013, Article ID 735147, 3 pages
Case Report

Pitfalls in Neuroimaging of Headache: A Case Report and Review of the Literature

1Department of Otolaryngology-Head and Neck Surgery, Aberdeen Royal Infirmary, Aberdeen AB252ZN, UK
2Department of Radiology, Aberdeen Royal Infirmary, Aberdeen, UK

Received 17 December 2012; Accepted 5 February 2013

Academic Editors: D. K. Chhetri and L. J. DiNardo

Copyright © 2013 V. Vallamkondu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Headache is a common symptom, with a lifetime prevalence of over 90% of the general population in the United Kingdom (UK). It accounts for 4.4% of consultations in primary care and 30% of neurology outpatient consultations. Neuroimaging is indicated in patients with red flag features for secondary headaches. The guidelines recommend CT or MRI scan to identify any intracranial pathology. We present a unique case where the initial noncontrast CT scan failed to identify a potential treatable cause for headache. A middle aged man presented with headache and underwent a CT scan without contrast enhancement. The scan was reported as normal. The headache persisted for years and the patient underwent a staging CT scan to investigate an oropharyngeal cancer. This repeat CT scan utilized contrast enhancement and revealed a meningioma. Along with other symptoms, headache is an established presenting complaint in patients with meningioma. The contrast enhanced CT brain proved superior to a nonenhanced CT scan in identifying the meningioma. In a patient with persistent headache where other causes are excluded and a scan is to be requested, perhaps contrast enhanced CT is a better option than a plain CT scan of brain.