A nonessential examination for patients with normal neurological examination in headache: Brain MRI

Aim: Headache is amongst the most common reasons of consulting a doctor. In addition to impairing the quality of life of the individual, there are societal as well as fiscal outcomes like workforce loss along with health expenditures. MRI findings of patients with headache were examined retrospectively through the relevant literature with a view to scrutinizing the necessity of the very procedure carried out, and the results were shared accordingly. Through our study we delved into the recent situation in our country and investigated whether MRI devices with advancing and novel technologies give dissimilar results with diffusion and sensitivity-weighted images in the MRI findings of patients who seek medical advice visiting a health institution with complaint of headache. 
 
Materials and Methods: The study included 224 patients over the age of 18, who underwent brain MRI between January 2020 and December 2021 in our center, with normal findings on neurological examination and who had not undergone surgery. All abnormal appearances such as mass, metastasis, aneurysm, hydrocephalus, encephalitis, sinusitis, mastoiditis, otitis, which may cause secondary headache, were recorded in MR images. 
 
Results: Of the 224 patients, 120 (53.57%) were male and 104 (46.43%) were female. The mean age was 39.45±12.55 years. None of the 224 examinations revealed mass suspicious for malignancy, aneurysm, encephalitis, or meningitis. Extraaxial mass lesion compatible with meningioma was detected in 3 patients (1.33%), arachnoid cyst in 3 patients (1.33%), and developmental venous anomaly in 2 patients (0.89%). There was paranasal sinus infection in 145 patients (64.73%), mastoiditis in 37 patients (16.52%), and otitis in 8 patients (3.57%). The remaining 66 patients had no MRI findings except ischemic-gliotic changes, enlarged perivascular distances, and physiological calcifications. 
 
Conclusion: In studies designed according to CT and MRI examinations taken regardless of neurological examination and history, the rate of completely normal findings is quite high, as in our study. MRI scans conducted for these patients, who can indeed solely be diagnosed with examination or simpler imaging methods, lead to loss of time and money. In order to fix the said situation, we are of the opinion that the red flag practice should become widespread and nonessential examination requests should be supervised.