Although usually benign, headache can herald serious intracranial disease. Neuroimaging must be considered whenever secondary causes of headache are suspected. Dr. Marmura of the Jefferson Headache Center at Thomas Jefferson University and Dr. Emara of Ain Shams University, Egypt, discuss both the contribution that neuroimaging has made to our understanding of headache pathophysiology and the indications for neuroimaging in clinical practice. Common abnormalities on exam and their relationship to headache are explored, as well as the yield of neuroimaging in various clinical situations. Recent advances in imaging, such as vascular changes in migraine and response to triptans, white matter changes in migraine over time, imaging findings in trigeminal autonomic cephalalgias, and reversible cerebral vasoconstriction syndromes, are highlighted.