A consultant neurologist for Legal Medicine Consultants, Dr. James C. Johnston earned his doctor of medicine from The University of Texas Health Science Center in San Antonio, and complete residency at the Texas Medical Center in Houston. Dr. James C. Johnston has written numerous scientific articles, including co-authoring a text entitled Migraine and Medical Malpractice for the American Headache Society.
In Migraine and Medical Malpractice, the authors discuss the role of neuroimaging in a patient with migraine headaches and a normal examination. The article specifically addresses the situation of a woman with a long history of migraines that progressively worsened despite an initial improvement on triptan medication.
In considering the woman’s condition, the authors pose the question of whether the evaluation should incorporate an MRI of the brain even though her neurological examination was normal. They concluded that she should have an MRI. Dr. Johnston recommended that physicians perform a complete history and physical examination on every patient with headache to determine the possibility of a serious underlying etiology such as brain tumor, aneurysm or other structural disease. The presence of warning signs – such as the increasing frequency of headaches in this patient – mandates further evaluation including neuroimaging.
The article goes on to answer questions such as how to respond if the MRI request receives denial in precertification, how to properly discuss medication side effects and other relevant points.