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Original Research (Original Article) 


Ahmed Ibrahim Hakami et al, 2020;4(3):735–739.

International Journal of Medicine in Developing Countries

MRI finding among patients presented to the radiology department compelling of headache

Ahmed Ibrahim Hakami1*, Ahmed Ali Kamli2, Abdullah Ahmed Rayyani3, Khalid Hasan Gadri4, Arwa Nasser Moafa2

Correspondence to: Ahmed Ibrahim Hakami

*Radiological Technology, Ahad Almsarha General Hospital, Jizan, Saudi Arabia.

Email: Ahihakami [at] moh.gov.sa

Full list of author information is available at the end of the article.

Received: 13 January 2020 | Accepted: 21 January 2020


ABSTRACT

Background:

Headache is considered as one of the most common chronic conditions. It can vary on the severity of mild-to-severe headaches. It can also be a symptom of other serious conditions, therefore, knowing the figures for headache diagnosis, and treatment is crucial. The goal of this study is to figure out the patients who suffer from headaches, the behavior of patients toward their headache, and to know the causes that may be seen by the public as causes of headaches.


Methodology:

The study included a self-administered questionnaire for the general public living in the Eastern area of Saudi Arabia. The survey explored demographic data, migraine diagnostic tools, and the effectiveness of the diagnosis by magnetic resonance imaging (MRI) test, and if it leads to a diagnosis or the cause of this disease whom many people suffer from, or even after the MRI test there will remain many people who suffer from headache for unknown reasons.


Results:

In the opinion of patients toward their diagnosis, there is a significant difference between different investigations in terms of patients’ opinions (p-value < 0.001). Patients who had an MRI were significantly higher to believe that they had migraine headaches (10.3%) followed by headache due to fatigue (6.5%). The attitude of patients toward headache varied significantly (p-value < 0.001). A significantly higher percentage of patients who had an MRI consult their doctors when they had a headache.


Conclusion:

MRI is a useful tool in the diagnosis of headache. Suspicion of migraine increases the chances of performing an MRI to the patients. Future studies in other regions of Saudi Arabia are essential.


Keywords:

Headache, attitude, diagnosis, symptoms, Saudi Arabia.


Introduction

Headache represents a common neurological condition that can occur at any stage of life [1]. It can represent an economic burden, in addition to reducing the patients’ quality of life [2]. Headache can be due to different reasons. These reasons can be as simple as stress, premenstrual symptoms, eye problems, otitis media, or sinusitis; however, it can be a symptom for more serious illness, such as hypertension or cancer [3].

There are different types of headaches, the most common of which are tension headache, cluster, and migraine headache [4]. The management strategy is decided based on the type of headache [5]. Moreover, the type of headache is usually identified through patients’ symptoms, as well as the radiological investigation that might be required in some conditions [6].

The management of headache should consider any secondary causes of headache, in parallel to treating the headache itself [7]. Analgesics are considered as the class of choice for the treatment of pain resulting from headache. Painkillers can be in the form of Nonsteroidal anti-inflammatory drug (NSAIDs) or paracetamol [8]. Other medications can also be used for the prevention of headaches, especially in the case of migraine headaches, most commonly propranolol [9].

MRI test is a cornerstone in the diagnosis of the causes of headache. Additionally, it has several advantages compared to other radiological techniques [10]. These include not using radiation as in X-ray, in addition to being a non-invasive technique. However, the major disadvantage of magnetic resonance imaging (MRI) in headache diagnosis is being contraindicated in the case of patients with implantable devices or prostheses, due to its magnetic power [11].

Despite the rich data in the medical literature about etiology and symptoms of headache, there is a scarcity of data about the awareness of the public about the effectiveness of the diagnosis by MRI test, and if it can detect the etiology of headache [10].

Therefore, this study aims at investigating the opinion of patients toward the diagnosis of headaches using MRI and if it can really detect the causes of headaches in the Eastern area of Saudi Arabia.


Subjects and Methods

This is a cross-sectional survey analysis study that was carried out in the Eastern region of Saudi Arabia. The study included adult members of the public. All responders who completed the survey were included in this study.

A self-administered questionnaire was distributed online to the public living in the Eastern area of Saudi Arabia. The Survey’s questions included socio-demographic data, diagnostic tools for headache, etiology, in addition to the effectiveness of the diagnosis by MRI test, and if it leads to a diagnosis or the cause of this disease whom many people suffer from, or even after the MRI test there will remain many people who suffer from headache for unknown reasons and the attitude of patients toward managing their headache.

All data were recorded in a pre-designed and validated excel sheet. Data were represented as frequencies and valid percentages for categorical variables. Correlations were done using the chi-square test for categorical variables at a level of significance p-value < 0.05. Data were further analyzed using IBM (Statistical Package for the Social Science; IBM Corp, Armonk, NY) to perform all statistical calculations, version 26 for Microsoft Windows.


Results

Of the 1,656 responders, 948 (57.2%) males and 708 (57.2%) females participated in this analysis. Age was categorized into six age groups. Patients aging between 21- and 30-year old represented 55.2% of the participants. On the other hand, only nine participants responded from the age group above 60-year old.

Regarding suffering from headaches, 87.4% of the responders suffered from headaches, while 12.6% of participants did not have a headache. All socio-demographic data are shown in detail in Table 1.

Participants were asked about their behavior toward headache symptoms; 68% of patients use analgesics to treat headaches, while 4% search the internet to find relief for their headache, and 4% of patients consult their doctors. All responses are demonstrated in Figure 1.

Table 1. Socio-demographic characters of responders.

Frequency (N) Percent (%)
Gender
Female 708 42.8
Male 948 57.2
Age
Less 20-year old 163 9.8
21- to 30-year old 914 55.2
31- to 40-year old 405 24.5
41- to 50-year old 108 6.5
51- to 60-year old 57 3.4
More than 60-year old 9 0.5
Do you suffer from headache
No 208 12.6
Yes 1,448 87.4

Figure 1. Participants' attitudes toward headaches.

Table 2. Diagnostic tools for headache.

Frequency (N) Percent (%)
X-ray 48 2.9
Computerized tomography 96 5.8
MRI 60 3.6
I did not consult a doctor 1,383 83.5

Participants were asked about how their headache was diagnosed; 83.5% of responders did not consult a physician’s diagnosis for their symptoms, while 2.9% of responders were diagnosed by X-ray, followed by 3.6% diagnosed by MRI. The responses are detailed in Table 2.

Responders were also asked about their diagnosis; 26.4% were diagnosed with different causes of headache, and 14.3% were diagnosed with a migraine headache. On the other hand, 0.2% of patients had a headache due to staying up late, and 0.8% of patients had a headache due to otitis media, and 6.1% of responders did not know the cause of their headache. All headache causes are detailed in Table 3.

Participants were also asked about their opinion about the cause of their headache; 22.3% of patients thought that sleep disorder is the reason for their headache, while 0.2% of participants believed that the cause of their headache was fatigue, neckache, and general headache.

Behavior toward headache was compared over different radiological investigations using the chi-square test at a p-value less than 0.05. Regarding the opinion of patients toward their diagnosis, it was revealed that there is a significant difference between different investigations in terms of patients’ opinions (p-value < 0.001).

Patients who had an MRI were significantly higher to believe that they had migraine headache (10.3%) followed by headache due to fatigue (6.5%), also patients who had an MRI did not think that their headache was due to otitis media, neckache or general headache.

As for the diagnosis, a significantly higher percentage of patients who had MRI, were diagnosed with migraine headache (8.1%), followed by headache due to fatigue (6.9%), while none of the patients was diagnosed with otitis media or headache due to sleep disorders.

Furthermore, the attitude of patients toward headache varied significantly (p-value < 0.001). A significantly higher percentage of patients who had an MRI consult their doctors when they had a headache. All comparison is detailed in Table 4.


Discussion

Headache is a common symptom in all age groups that causes a significant reduction in the productivity of the patients [12]. Additionally, it can signal a more severe condition [13]. Symptoms and causes of headache have been rigorously examined [14]. However, there is a scarcity of data on the relation between MRI and diagnosis of headache from a patient perspective [15].

Table 3. Causes of headache in the whole cohort.

Frequency (N) Percent (%)
Otitis media 13 0.8
Hypertension 75 4.5
Staying up late 3 0.2
Tension headache 87 5.3
Migraine headache 237 14.3
Headache due to eye problems 113 6.8
Headache due to fatigue 87 5.3
I don’t know 101 6.1
Others 438 26.4

The present study aimed at evaluating the patients who suffer from headaches, the behavior of patients toward their headache, and to know the causes that may be seen by the public as causes of headache in the Eastern region of Saudi Arabia. It was revealed that the opinion of patients towards their diagnosis, there is a significant difference between different investigations in terms of patients’ opinions (p-value < 0.001). Patients who had an MRI were significantly higher to believe that they had migraine headaches (10.3%) followed by headache due to fatigue (6.5%).

As for the diagnosis, a significantly higher percentage of patients who had MRI were diagnosed by migraine headaches (8.1%), followed by headache due to fatigue (6.9%). The attitude of patients toward headache varied significantly (p-value < 0.001). A significantly higher percentage of patients who had an MRI consult their doctors when they had a headache.

The relation between MRI and diagnosis of headache have been examined in previous studies. Kurth et al. [16] examined the correlation between different types of headaches and MRI examinations. Kurth et al. [16] included 780 participants in his study and showed that patients with migraine headaches are more likely to be investigated using MRI.

Although the present study examined the relationship between MRI and diagnosis of headache through a population survey, it showed a similar correlation between migraine headache and MRI, where patients who believed that they had a migraine, were more likely to undergo an MRI, also they had a positive attitude toward their symptoms. Additionally, the present study considered all types of investigation, compared to only MRI used in Kurth et al. [16] study.

Also, Gozke et al. [17] evaluated the frequency of MRI positive findings in migraine patients. Althrough MRI reports of 45 patients, Gozke et al. [17] showed that white matter foci were more dominant in patients with migraine especially in cases of migraines with aura patients.

The present study showed a significantly higher migraine diagnosis with patients who undergo MRI investigation, therefore, and based on the findings of Gozke et al. [17], it is strongly recommended to consider the clinical manifestation of the patients and detailed description of their headaches to choose the best investigation for diagnosis.

Furthermore, Schwedt et al. [18] explained the importance of functional MRI in detecting the causes of migraine headaches. This, in turn, can help with understanding the different triggers of migraines in addition to exploring the mechanisms of this type of headache.

Table 4. Comparison of attitude towards headache and headache diagnosis using a Chi-square test.

X-ray CT MRI I did not consult a doctor p-value
In your opinion, what was the cause of a headache? Otitis media 0.0% 0.0% 0.0% 75.0% <0.001*
Sleep disorder 1.6% 4.1% 3.3% 91.0%
Tension headache 1.4% 2.9% 4.3% 87.1%
Migraine headache 0.0% 15.4% 10.3% 69.1%
Hypertension 8.1% 5.4% 5.4% 73.0%
Neckache 100.0% 0.0% 0.0% 0.0%
Sinusitis headache 3.5% 7.1% 4.7% 78.8%
Headache due to eye problems 3.7% 5.5% 1.8% 83.4%
General headache 0.0% 0.0% 0.0% 100.0%
Headache due to fatigue 3.2% 0.0% 6.5% 87.1%
Psychic headache 0.0% 9.0% 4.5% 86.6%
Others 4.8% 4.8% 1.6% 88.7%
What was the diagnosis Otitis media 0.0% 0.0% 0.0% 76.9% <0.001*
Hypertension 8.0% 0.0% 8.0% 80.0%
Staying up late 0.0% 0.0% 0.0% 100.0%
Tension headache 3.4% 3.4% 6.9% 86.2%
Migraine headache 2.5% 12.7% 8.9% 74.7%
Headache due to eye problems 5.3% 10.6% 2.7% 73.5%
Headache due to fatigue 3.4% 0.0% 6.9% 89.7%
I don’t know 0.0% 3.0% 0.0% 97.0%
Others 4.1% 11.0% 2.1% 82.9%
Your attitude towards the headache I search the internet 0.0% 4.8% 4.8% 90.3% <0.001*
I ignore it 0.0% 3.9% 1.9% 86.4%
I take analgesics 3.2% 6.4% 2.9% 84.6%
I use alternative medicine 7.5% 3.8% 0.0% 88.8%
I consult my doctor 8.1% 8.1% 24.3% 43.2%

*p-value at a level of significance < 0.05.

Although the present study did not include the findings of the investigations, it was revealed from the patients' responses that patients with migraine headaches are more likely to undergo an MRI investigation.

However, the present study has some limitations. Limiting responses to the patients living in the Eastern area can limit the external validity of the results of this study. Also, the study evaluated the attitude of patients without assessing their knowledge of different types of investigations used to diagnose headaches, which should be considered in any future studies.

Finally, to our knowledge, this is the first study to evaluate the relationship between MRI and the diagnosis of headache in the Eastern region of Saudi Arabia.


Conclusion

MRI is a useful tool in the diagnosis of headache. Suspicion of migraine increases the chances of performing an MRI to the patients. Therefore, it is very important to consider seriously the patients' description for headaches Also, other similar studies are encouraged in other areas of Saudi Arabia to figure out the national figures for the relationship between headache diagnosis and MRI investigation all over Saudi Arabia.


Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

The research was done under the supervision of Ahad Almsarha General.


Author details

Ahmed Ibrahim Hakami1, Ahmed Ali Kamli2, Abdullah Ahmed Rayyani3, Khalid Hasan Gadri4, Arwa Nasser Moafa2

  1. Radiological Technology, Ahad Almasarha General Hospital, Jizan, Saudi Arabia
  2. Radiological Technology, King Fahd Hospital, Jazan, Saudi Arabia
  3. Radiological Technology, Sabya General Hospital, Jizan, Saudi Arabia
  4. Radiological Technology, Prince Mohammed bin Nasser Hospital, Jizan, Saudi Arabia

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How to Cite this Article
Pubmed Style

Hakami AI, Kamli AA, Rayyani AA, Gadri KH, Moafa AN. MRI finding among patients presented to the radiology department compelling of headache. IJMDC. 2020; 4(3): 735-739. doi:10.24911/IJMDC.51-1578905742


Web Style

Hakami AI, Kamli AA, Rayyani AA, Gadri KH, Moafa AN. MRI finding among patients presented to the radiology department compelling of headache. http://www.ijmdc.com/?mno=81775 [Access: March 29, 2020]. doi:10.24911/IJMDC.51-1578905742


AMA (American Medical Association) Style

Hakami AI, Kamli AA, Rayyani AA, Gadri KH, Moafa AN. MRI finding among patients presented to the radiology department compelling of headache. IJMDC. 2020; 4(3): 735-739. doi:10.24911/IJMDC.51-1578905742



Vancouver/ICMJE Style

Hakami AI, Kamli AA, Rayyani AA, Gadri KH, Moafa AN. MRI finding among patients presented to the radiology department compelling of headache. IJMDC. (2020), [cited March 29, 2020]; 4(3): 735-739. doi:10.24911/IJMDC.51-1578905742



Harvard Style

Hakami, A. I., Kamli, . A. A., Rayyani, . A. A., Gadri, . K. H. & Moafa, . A. N. (2020) MRI finding among patients presented to the radiology department compelling of headache. IJMDC, 4 (3), 735-739. doi:10.24911/IJMDC.51-1578905742



Turabian Style

Hakami, Ahmed Ibrahim, Ahmed Ali Kamli, Abdullah Ahmed Rayyani, Khalid Hasan Gadri, and Arwa Nasser Moafa. 2020. MRI finding among patients presented to the radiology department compelling of headache. International Journal of Medicine in Developing Countries, 4 (3), 735-739. doi:10.24911/IJMDC.51-1578905742



Chicago Style

Hakami, Ahmed Ibrahim, Ahmed Ali Kamli, Abdullah Ahmed Rayyani, Khalid Hasan Gadri, and Arwa Nasser Moafa. "MRI finding among patients presented to the radiology department compelling of headache." International Journal of Medicine in Developing Countries 4 (2020), 735-739. doi:10.24911/IJMDC.51-1578905742



MLA (The Modern Language Association) Style

Hakami, Ahmed Ibrahim, Ahmed Ali Kamli, Abdullah Ahmed Rayyani, Khalid Hasan Gadri, and Arwa Nasser Moafa. "MRI finding among patients presented to the radiology department compelling of headache." International Journal of Medicine in Developing Countries 4.3 (2020), 735-739. Print. doi:10.24911/IJMDC.51-1578905742



APA (American Psychological Association) Style

Hakami, A. I., Kamli, . A. A., Rayyani, . A. A., Gadri, . K. H. & Moafa, . A. N. (2020) MRI finding among patients presented to the radiology department compelling of headache. International Journal of Medicine in Developing Countries, 4 (3), 735-739. doi:10.24911/IJMDC.51-1578905742