The Roentgen-Ray Findings in a Series of Cases of Headache

Abstract

IT is a generally recognized fact that there are many causes of headache. It will occasion no surprise, therefore, that the roentgen-ray findings in cases of headache present usually a wide range of variation. It happens not infrequently, however, that a roentgenogram, even in cases of very severe and obstinate headache, gives a negative result. That is particularly true of the various types of nervous cephalalgia (in neurasthenics), and likewise of headache associated with vasomotor disturbances, which are caused by anemia, by venous stasis in heart and lung diseases, or by congestions. The conditions are similar in toxic headaches resulting from intoxicating poisons; in auto-intoxications of gastro-intestinal, uremic and diabetic origin, and in infectious diseases. Finally, there should be mentioned, in this connection, the traumatic headache. If the positive roentgen-ray findings in cases of headache are classified according to the anatomic changes visible in the roentgenogram, one may distinguish destructive and hyperosteogenic changes in the cranial bones, modifications in form and size of all (or of certain portions of) the skull, changes in the vascular grooves and sutures, residua of traumatic action on the skull, affections of the accessory sinuses of the nose, and, finally, focal or diffuse changes in the interior of the skull. The various types of headache, in which, frequently, positive roentgen-ray findings may be recorded, may be classified in the following groups: (1) syphilis and various other inflammations, also neoplasms of the skull; (2) traumata of the head; (3) organic affections of the brain and meninges; (4) affections of the cerebral arteries, and (5) affections of the accessory sinuses of the cranium. I will begin with a description of certain changes in the cranium in syphilis which so often give rise to obstinate headaches. One of the most frequent pictures is that of circumscribed osteoperiostitis of the cranial dome. It occurs in single or multiple foci, being particularly common in the region of the tubera. The size of the foci varies from that of a finger nail to that of the palm of the hand. In the roentgenogram the foci appear as light colored spots. Viewed in profile (in tangential photographs) the contour of the lamina externa and the lamina interna appears jagged or dentate, while the diploë presents irregular shades of light and dark. Sometimes one sees, in addition to the described osteoporotic foci, two other types of syphilitic bone destruction; namely, the transparencies produced by gummata, roundish or kidney-shaped, not sharply circumscribed, defects, and reticular transparencies, which correspond to the ramifications of the diploic vein channels of the cranial dome, since the syphilitic granulation tissue shows a predilection for the course along the channels of the diploë and attacks the bones bordering on those channels.