Neuroimaging of headache

Introduction
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By Farnaz Amoozegar MD and Werner J Becker MD

Headache is probably the most common neurologic symptom. Although usually of benign origin, headache can herald serious intracranial disease. As a result, neuroimaging must be considered in all patients with headache but will be productive only in a small minority. In this clinical article, Dr. Farnaz Amoozegar and Dr. Werner Becker, both of the University of Calgary in Alberta, Canada, try to bring order to this dilemma. They discuss both the contribution that neuroimaging has made to our understanding of headache pathophysiology and the indications for neuroimaging in clinical practice. The authors discuss recent practice guidelines. They also include recent advances in the imaging of spontaneous intracranial hypotension, including discussion of new modalities such as heavily T2-weighted MR myelography, in addition to cluster headache and SUNCT. They also discuss the yield of neuroimaging procedures in patients who are referred to a neurologic practice with primary headache disorders.

Key points

  • Not all cases of headache require neuroimaging.
  • When deciding whether or not to image a patient with headache, think about the “red flags.”
  • Neuroimaging should be strongly considered in rarer types of primary headaches, such as the trigeminal autonomic cephalalgias, cough, or exertional headaches, etc.