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Use of cerebral imaging in patients with headaches.

The article by Weingarten et al 1 provides a very important contribution to the debate on the role of cerebral imaging in patients with headaches. Finding the most appropriate strategy of evaluating patients with headaches that balances the need for early diagnosis of serious conditions and patient reassurance with cost-effectiveness is difficult, especially since most headaches resulting from brain tumors do not have features of increased intracranial pressure and are often indistinguishable from tension headaches. 2 Although we would agree that most patients with headaches do not need cerebral imaging unless they have other symptoms and signs suggestive of an intracranial lesion, there is a group of patients with brain tumors who have headches as the sole presenting symptom and no neurologic findings. In a retrospective review (unpublished data) of 100 consecutive patients with malignant gliomas operated on at Brigham and Women's Hospital, Boston, Mass, 30 patients had headaches as