Headache-Related Neuroimaging

Aka: Headache-Related Neuroimaging, Neuroimaging in Headache

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II. Indications: Head Imaging (typically MRI Brain with and without contrast)

  1. See Headache Red Flags
  2. Trigeminal autonomic Cephalgia (Cluster Headache, Paroxysmal Hemicrania, Hemicrania Continua, SUNCT Syndrome)
  3. Headache with new features or neurologic deficits
  4. Suspected intracranial abnormality
  5. Chronic Progressive Headache over weeks to months
    1. Neuroimaging recommended for organic Headache Evaluation, but yield is 1%

III. Protocol: Imaging selection

  1. Immunocompromised
    1. MRI Head with and without contrast
  2. Temporal Arteritis suspected in age >60 years
    1. MRI Head with and without contrast
    2. Requires starting Corticosteroids and obtaining temporal artery biopsy
  3. Suspected Meningitis
    1. CT Head or MRI Head without contrast
    2. Start antibiotics and obtain Lumbar Puncture
  4. Pregnancy and severe Headache
    1. MRI Head (preferred) or CT Head
  5. Suspected carotid dissection with severe unilateral Headache
    1. MRI Head with and without contrast and MRA of the head and neck OR
    2. CTA head and neck
  6. Sudden onset severe Headache (first or worst, thunderclap)
    1. CT Head without contrast followed by CTA Head or Lumbar Puncture or
    2. MRI Head with and without contrast and MRA Head

IV. References

  1. Strain (2000) Radiology 215(suppl):855-60 [PubMed]
  2. Douglas (2014) J Am Coll Radiol 11(7): 657-67 [PubMed]

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