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In Reply: We agree with the suggestion made by Dr Brenner that not all sinister causes of headaches will be discovered by neuoroimaging. Examples of such etiologies are temporal arteritis and bacterial meningitis. This emphasizes the importance of thorough history taking and physical examination in a patient with headache. Pertinent findings during this initial portion of the clinical examination may serve to guide further diagnostic tests or therapy.

Financial Disclosures: None reported.

Michael E. Detsky, BSc; Devon R. McDonald, BSc; Christopher M. Booth, MD, FRCPC
christopher.booth@utoronto.ca
University of Toronto
Toronto, Ontario

JAMA. 2007;297:42.

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