Tips on when to request an imaging assessment (RMI, CT, or angiography) in a patient suffering from a headache

Authors

DOI:

https://doi.org/10.48208/HeadacheMed.2021.46

Keywords:

Headache, Magnetic Resonance Imaging, Tomography, X-Ray Computed, Migraine Disorders, Cluster Headache, Red flags

Abstract

This article is a mini-narrative review covering practical aspects of when to request an imaging evaluation of a headache patient. The vast majority of patients who seek help in a medical office receive as a diagnostic hypothesis one of the primary headaches, such as migraine, tension-type headache, or cluster headache. The vast majority of patients who arrive with a headache at the neurologist's office are migraineurs; individuals who suffer from tension-type headaches rarely seek the neurologist's help. In the emergency scenario, there is a more significant occurrence of secondary headaches when compared to patients treated in an outpatient clinic. In evaluating a patient with a headache, the physician should pay attention to red flags or signs that may indicate a secondary cause for the pain the patient reports. In primary headaches, with the exception of trigeminal-autonomic headaches, there is no need to investigate by imaging. In cluster headaches, in some cases, intracranial lesions may be found as the cause, mainly parasellar lesions such as cerebral aneurysms. Thus, image evaluation is indicated. Depending on the diagnostic suspicion in secondary headaches, different imaging examinations should be requested, the most frequent being MRI, CT, and angiography.

Keywords: Headache, Magnetic Resonance Imaging, Tomography, X-Ray Computed, Migraine Disorders, Cluster Headache, Red flags

Downloads

Download data is not yet available.

References

Parizel PM, Voormolen M, Van Goethem JW and van den Hauwe L. Headache: when is neuroimaging needed? JBR-BTR 2007;90(4):268-271, https://www.ncbi.nlm.nih.gov/pubmed/17966243

Headache Classification Committee of the International Headache S. The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013;33(9):629-808 Doi:10.1177/0333102413485658 DOI: https://doi.org/10.1177/0333102413485658

Holle D and Obermann M. The role of neuroimaging in the diagnosis of headache disorders. Ther Adv Neurol Disord 2013;6(6):369-374 Doi:10.1177/1756285613489765 DOI: https://doi.org/10.1177/1756285613489765

Joswig H, Fournier JY, Hildebrandt G and Stienen MN. Sentinel Headache: A Warning Sign Preceding Every Fourth Aneurysmal Subarachnoid Hemorrhage. AJNR Am J Neuroradiol 2015;36(9):E62-63 Doi:10.3174/ajnr.A4467 DOI: https://doi.org/10.3174/ajnr.A4467

Evans RW. Diagnostic testing for the evaluation of headaches. Neurol Clin 1996;14(1):1-26 Doi:10.1016/s0733-8619(05)70240-1 DOI: https://doi.org/10.1016/S0733-8619(05)70240-1

Hougaard A, Amin FM and Ashina M. Migraine and structural abnormalities in the brain. Curr Opin Neurol 2014;27(3):309-314 Doi:10.1097/WCO.0000000000000086 DOI: https://doi.org/10.1097/WCO.0000000000000086

Kruit MC, van Buchem MA, Launer LJ, Terwindt GM and Ferrari MD. Migraine is associated with an increased risk of deep white matter lesions, subclinical posterior circulation infarcts and brain iron accumulation: the population-based MRI CAMERA study. Cephalalgia 2010;30(2):129-136 Doi:10.1111/j.1468-2982.2009.01904.x DOI: https://doi.org/10.1111/j.1468-2982.2009.01904.x

Kellner-Weldon F, El-Koussy M, Jung S, Jossen M, Klinger-Gratz PP and Wiest R. Cerebellar Hypoperfusion in Migraine Attack: Incidence and Significance. AJNR Am J Neuroradiol 2018;39(3):435-440 Doi:10.3174/ajnr.A5508 DOI: https://doi.org/10.3174/ajnr.A5508

Pollock JM, Deibler AR, Burdette JH, Kraft RA, Tan H, Evans AB and Maldjian JA. Migraine associated cerebral hyperperfusion with arterial spin-labeled MR imaging. AJNR Am J Neuroradiol 2008;29(8):1494-1497 Doi:10.3174/ajnr.A1115 DOI: https://doi.org/10.3174/ajnr.A1115

Stovner LJ and Andree C. Prevalence of headache in Europe: a review for the Eurolight project. J Headache Pain 2010;11(4):289-299 Doi:10.1007/s10194-010-0217-0 DOI: https://doi.org/10.1007/s10194-010-0217-0

Downloads

Published

2022-03-24

How to Cite

1.
Aragão M de FVV, Araújo LC, Valença MM. Tips on when to request an imaging assessment (RMI, CT, or angiography) in a patient suffering from a headache. Headache Med [Internet]. 2022 Mar. 24 [cited 2024 Dec. 13];12(4):283-6. Available from: https://headachemedicine.com.br/index.php/hm/article/view/597

Issue

Section

Review

Most read articles by the same author(s)

1 2 3 4 5 6 7 8 9 10 > >>