Laboratory and instrumental methods of research for headaches

Laboratory and instrumental methods of research for headaches

Patients with chronic headaches are not prescribed laboratory blood tests. They can be recommended to patients in the presence of clinical signs of concomitant disease, as well as to persons over 50 years old to exclude giant cell arteritis, also called temporal arteritis.

Recommended laboratory tests:

1. Immunodiagnostics (with antinuclear antibodies)
2. Complete blood count – an increase in erythrocyte sedimentation rate (ESR) or C-reactive protein may indicate giant cell arteritis in patients with newly developed headaches or over the age of 50 years.
3. Biochemical analysis of blood (electrolytes, functional tests of the liver and kidneys)
4. Endocrinological examination (thyroid function)
5. Identification of infectious agents (plasma express reagent for the diagnosis of syphilis)

Neuroimaging for headaches

Patients with chronic headaches, at least until they have specific indications, do not conduct neuroimaging studies. The indications for their conduct are articular pathology, a qualitative change in the nature of headaches, the presence of neurological symptoms and mental disorders, epileptic seizures. For headaches of non-traumatic etiology or pains that do not require emergency treatment, MRI is preferable to CT. Unfortunately, in the vast majority of patients suffering from headache, only clinically insignificant changes are detected on the roentgenogram and MRI.

On radiography of the cervical spine in adults mainly reveal degenerative changes. Radiological osteochondrosis of the cervical spine was detected in 159 adults (aged 20-65 years) in the initial study and after 10 years. As a result of a primary X-ray examination in a third of patients, and after a secondary (10 years later), more than half of the patients on radiographs in the lateral projection showed changes in the lower cervical spine.

Despite the fact that over the past 10 years, only 15% of patients felt pain in the neck, progressive degenerative changes were noted in 45% of them. Although the changes were detected at several levels, most often they were found at the CV_VI level. The frequency of radiological signs of degenerative changes in the cervical spine increases with age and at the age of 60-65 years is 70% among women and 95% among men.

Every third patient suffering from migraine, on MRI revealed clinically insignificant changes in the white matter of the brain. Such changes cause unfounded concerns about the possibility of diseases such as multiple sclerosis, cerebrovascular disease or a malignant tumor.

In clinical practice, when conducting a follow-up study after 6 months, such foci may disappear or remain. For this reason, routine X-ray examination of patients with chronic headaches is not performed.

MRI of the cervical spine also often reveals clinically insignificant changes at several levels in clinically healthy people. So, according to one study, 37% of adults show an asymptomatic fibrous ring rupture with disc protrusion in 73% and a hernia in 50%. These changes were more often localized in the lower cervical spine, mainly at the level of CV_VI.

local_offerevent_note December 13, 2018

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