ACR: Imaging Not Usually Needed for Uncomplicated Headache

Uncomplicated, nontraumatic, primary headache do not generally require imaging for definitive diagnosis, although if red flags are present, imaging may be warranted, according to an article published in the Journal of the American College of Radiology.

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The article reviews the ACR Appropriateness Criteria for diagnosis of headache. The evidence-based guidelines for specific clinical conditions are reviewed every two years. “Several studies have confirmed the low yield of imaging procedures for individuals presenting with isolated headache, ie, headache unaccompanied by other neurological findings,” the authors wrote. “Therefore, when considering a common disorder, such as headache, indications for imaging become relevant.”

Clinical features or red flags that may indicate the need for imaging for headache include:

• Headache associate with trauma

• New, worse, or abrupt onset or headache

• Thunderclap (sudden onset of severe headache)

• Pain radiating to the neck

• Pain due to trigeminal autonomic cephalgia

• Persistent and positional pain

• Temporal pain in older individuals

Other patients who may benefit from imaging include those who:

• Are pregnant

• Are immunocompromised

• Have cancer

• Have papilledoma or systemic illnesses, including hypercoagulable disorders

• Have headache associated with cough, exertions or sexual activity

Imaging may also be useful for patients who present headaches in the base of the skull, or of rhinogenic, odontogenic or maxillofacial origin.