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INVESTIGATIONS OF HEADACHES: BRAIN SCANNING
In certain cases of headache, a brain scan, of which there are two types, may need to be done. One type relies on the uptake of a radioactive isotope by abnormal tissue, such as a tumour. The patient is given an injection of a short-lived radioactive isotope into an arm vein from where it enters the arterial system and goes through the brain, ascending via the carotid arteries. By using a camera the isotope is followed up the carotid arteries to each cerebral hemisphere, where the radioactivity is then ‘washed out’. The flow of the isotope through the brain helps to distinguish between a tumour, which has a relatively high flow, and a stroke in which case the flow is very low. It is a quick and easy test to do but is not available in every hospital.
The other type of scanning is also quick and easy but is even less readily available, although it has revolutionized diagnosis. Computerized axial tomographic (CT or CAT) scanning examines ’slices’ of brain by moving the X-ray machine in such a way that the slice is motionless relative to the areas in front of, and behind, it. The moving areas become blurred while the ’slice’ – the area to be examined – retains its sharpness and is defined more clearly. The CT technique depends on the fact that different tissues absorb different amounts of radiation so that it is then easy to identify the different structures to see if there is any abnormality. Its precise place in migraine is still controversial but some reports suggest that in very severe cases there may be evidence of persistent brain changes.
These investigations carry no risk and are performed without fear of complication. Rarely, other X-ray techniques, which rely on the introduction of substances opaque to X-ray into either blood vessels (arteriography) or the subarachnoid space (air encephalography), have to be done in order to define the structures more clearly on X-ray films. These tests are often done under a general anesthetic.
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