The role of headache management in minor head injury before performing brain CT scan--can intravenous morphine sulfate predict intracranial injury?

Background: The aim of this study was to examine the association between the responses of headache to IV morphine and the findings of brain CT scan in minor head injury (MHI), and to propose a new risk indicator to identify patients requiring CT scanning.

Methods: A total of 1857 MHI patients ≥15 years of age, presenting with headache and a GCS score of 14 or 15 were included in the study. Intravenous morphine sulfate was administered, and thereafter, patients were assessed for the relief or persistence of headache. Subsequently, a brain CT scan was obtained from all patients.

Results: Patients were divided into two age groups: 15-60 and >60 years. There was a significant association between the response of headache to morphine and the result of brain CT in both age groups (p<0.001). In patients aged between 15 and 60, none whose headache had responded to morphine showed any abnormal findings in CT scan (sensitivity=100%). In the >60 group, sensitivity was 58.3% for abnormal CT and 71.4% for neurosurgical intervention.

Conclusion: This study suggests that a headache not relieved by morphine is a risk indicator for intracranial injury. This protocol can be used in rural areas with limited access to CT scan as an adjunct to the existing criteria for selecting patients with MHI for CT scanning.