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November 6, 1981

Evaluation of Headache

Author Affiliations

Boston University Medical Center

JAMA. 1981;246(18):2031. doi:10.1001/jama.1981.03320180023015

To the Editor.—  The rationale for the use of the computed tomography (CT) scan for the evaluation of headaches in patients with normal neurological examination findings has been questioned by some authors (1980; 243:359).1 We certainly are not advocating the widespread use of CT for these patients; rather, we believe that certain clues can help the examining physician to decide which patients to give priority for scans.In our experience there are certain types of lesions in the brain that produce headache as a prominent feature, but in which it is not unusual to find no focal neurological deficits, even in an advanced stage of disease. Most of these lesions are closely related to the ventricular system and may or may not produce an obstructive hydrocephalus.Hydrocephalus from any cause is commonly associated with headaches—with the possible exception of the so-called normal pressure hydrocephalus. It is possible for headaches