Skip to main content

Advertisement

SpringerLink
Log in

Appropriate Use of Neuroimaging in Headache

  • Imaging (L Mechtler, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Headache may be caused by primary disorders, such as migraines, or secondary disorders, such as intracranial neoplasm or hemorrhage. Imaging plays an important role in differentiating between primary and secondary headache disorders. This article reviews the effectiveness of computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of a patient with a headache. It also discusses the utility and cost-effectiveness of performing imaging studies in patients with a headache and a normal neurological exam. Emerging imaging techniques such as functional MRI, positron emission tomography (PET) scans, and voxel-based morphometry (VBM) are also discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Rasmussen BK et al. Epidemiology of headache in a general population—a prevalence study. J Clin Epidemiol. 1991;44(11):1147–57.

    Article  CAS  PubMed  Google Scholar 

  2. Robbins MS, Lipton RB. The epidemiology of primary headache disorders. Semin Neurol. 2010;30(2):107–19.

    Article  PubMed  Google Scholar 

  3. Lipton RB, Goadsby P, Silberstein SD. Classification and epidemiology of headache. Clin Cornerstone. 1999;1(6):1–10.

    Article  CAS  PubMed  Google Scholar 

  4. Gaughran CG, Tubridy N. Headaches, neurologists and the emergency department. Ir Med J. 2014;107(6):168–71.

    CAS  PubMed  Google Scholar 

  5. Medina LS, M Debayle, and E Vasconcellos, Headache disorders: evidence-based neuroimaging, in evidence-based neuroimaging diagnosis and treatment, L.S. Medina, P. Sanelli, and J. Jarvik, Editors. 2013, Springer New York. p. 401–418. This particular paper is a comprehensive review for neuroimaging in headache disorders that provides a decision tree for adult and pediatric patients, for providers to use in their diagnostic workup.

  6. Evans RW. Diagnostic testing for the evaluation of headaches. Neurol Clin. 1996;14(1):1–26.

    Article  CAS  PubMed  Google Scholar 

  7. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Headache Classification Committee of the International Headache Society. Cephalalgia, 1988. 8 Suppl 7: p. 1–96.

  8. Clinch CR. Evaluation of acute headaches in adults. Am Fam Physician. 2001;63(4):685–92.

    CAS  PubMed  Google Scholar 

  9. Turner DP, Houle TT. Psychological evaluation of a primary headache patient. Pain Manag. 2013;3(1):19–25.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Tsushima Y, Endo K. MR imaging in the evaluation of chronic or recurrent headache. Radiology. 2005;235(2):575–9.

    Article  PubMed  Google Scholar 

  11. Steiner TJ. Evaluation and management of headache in primary care. Expert Rev Neurother. 2004;4(3):425–37.

    Article  PubMed  Google Scholar 

  12. Sempere AP et al. Neuroimaging in the evaluation of patients with non-acute headache. Cephalalgia. 2005;25(1):30–5.

    Article  CAS  PubMed  Google Scholar 

  13. Martin VT. The diagnostic evaluation of secondary headache disorders. Headache. 2011;51(2):346–52.

    Article  PubMed  Google Scholar 

  14. Lewis DW, Koch T. Headache evaluation in children and adolescents: when to worry? When to scan? Pediatr Ann. 2010;39(7):399–406.

    Article  PubMed  Google Scholar 

  15. Lester MS, Liu BP. Imaging in the evaluation of headache. Med Clin North Am. 2013;97(2):243–65.

    Article  PubMed  Google Scholar 

  16. Donohoe CD. The role of the physical examination in the evaluation of headache. Med Clin North Am. 2013;97(2):197–216.

    Article  PubMed  Google Scholar 

  17. Donohoe CD. The role of laboratory testing in the evaluation of headache. Med Clin North Am. 2013;97(2):217–24.

    Article  PubMed  Google Scholar 

  18. Brenner M, Oakley C, Lewis D. The evaluation of children and adolescents with headache. Curr Pain Headache Rep. 2008;12(5):361–6.

    Article  PubMed  Google Scholar 

  19. Breen DP et al. Emergency department evaluation of sudden, severe headache. QJM. 2008;101(6):435–43.

    Article  CAS  PubMed  Google Scholar 

  20. Berdahl CT et al. Emergency department computed tomography utilization in the United States and Canada. Ann Emerg Med. 2013;62(5):486–494 e3. This article highlighted CAT scan utilization trends in the United States and Canada and shows how frequently we use cat scans in the United States compared to Canada. The article also discusses the financial costs and risk of adverse events from overuse of the study.

    Article  PubMed  Google Scholar 

  21. Frishberg BM. Neuroimaging in presumed primary headache disorders. Semin Neurol. 1997;17(4):373–82.

    Article  CAS  PubMed  Google Scholar 

  22. Rizk B et al. The role of unenhanced CT alone for the management of headache in an emergency department. A feasibility study. J Neuroradiol. 2013;40(5):335–41.

    Article  PubMed  Google Scholar 

  23. Mettler Jr FA et al. Medical radiation exposure in the U.S. in 2006, preliminary results. Health Phys. 2008;95(5):502–7.

    Article  CAS  PubMed  Google Scholar 

  24. Health Quality O. Neuroimaging for the evaluation of chronic headaches: an evidence-based analysis. Ont Health Technol Assess Ser. 2010;10(26):1–57.

    Google Scholar 

  25. Berrington De Gonzalez A et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med. 2009;169(22):2071–7.

    Article  PubMed  Google Scholar 

  26. DeVries A et al. CT scan utilization patterns in pediatric patients with recurrent headache. Pediatrics. 2013;132(1):e1–8.

    Article  PubMed  Google Scholar 

  27. Reports C. Many common medical tests and treatments are unnecessary: learn when to say ‘Whoa!’ to your doctor. Consumer Reports, 2012.

  28. Akpek S et al. Cost-effectiveness of computed tomography in the evaluation of patients with headache. Headache. 1995;35(4):228–30.

    Article  CAS  PubMed  Google Scholar 

  29. Kahn Jr CE et al. Computed tomography for nontraumatic headache: current utilization and cost-effectiveness. Can Assoc Radiol J. 1993;44(3):189–93.

    PubMed  Google Scholar 

  30. Larson EB, Omenn GS, Lewis H. Diagnostic evaluation of headache Impact of computerized tomography and cost-effectiveness. JAMA. 1980;243(4):359–62.

    Article  CAS  PubMed  Google Scholar 

  31. Holle D, Obermann M. The role of neuroimaging in the diagnosis of headache disorders. Ther Adv Neurol Disord. 2013;6(6):369–74. This article provides “red flags” and parts of the physical exam to focus on when identifying a role for obtaing neuroimaging.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Kranz P, Provenzale J. Imaging “worst headache of my life”: part 1. Applied Radiology. 2013;7(42):19–23.

    Google Scholar 

  33. Douglas AC et al. ACR appropriateness criteria headache. J Am Coll Radiol. 2014;11(7):657–67. This article specifically reviews primary and secondary disorders and provides the specific studies which should be ordered for each condition based on expert opinion from radiology.

    Article  PubMed  Google Scholar 

  34. Klink T, et al., Giant cell arteritis: diagnostic accuracy of MR imaging of superficial cranial arteries in initial diagnosis-results from a multicenter trial. Radiology, 2014: p. 140056.

  35. Saindane AM et al. Association of MRI findings and visual outcome in idiopathic intracranial hypertension. American Journal of Roentgenology. 2013;201(2):412–8.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Bashir A et al. Migraine and structural changes in the brain: a systematic review and meta-analysis. Neurology. 2013;81(14):1260–8.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Dinia L et al. White matter lesions progression in migraine with aura: a clinical and MRI longitudinal study. Journal of Neuroimaging. 2013;23(1):47–52.

    Article  PubMed  Google Scholar 

  38. Hamedani AG et al. Migraine and white matter hyperintensities: the ARIC MRI study. Neurology. 2013;81(15):1308–13.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Seneviratne U, Chong W, Billimoria PH. Brain white matter hyperintensities in migraine: clinical and radiological correlates. Clin Neurol Neurosurg. 2013;115(7):1040–3.

    Article  PubMed  Google Scholar 

  40. Maniyar FH et al. Brain activations in the premonitory phase of nitroglycerin-triggered migraine attacks. Brain. 2014;137(1):232–41.

    Article  PubMed  Google Scholar 

  41. Kara B et al. DTI findings during spontaneous migraine attacks. Clin Neuroradiol. 2013;23(1):31–6.

    Article  CAS  PubMed  Google Scholar 

  42. Magon S., et al., Multi-center 3T MRI study of thalamic morphology in migraine using label-fusion-based segmentation and deformation based morphometric surface analysis. Neurology, 2014. 82 (10).

  43. Olesen J. ICHD-3 beta is published use it immediately. Cephalalgia. 2013;33(9):627–8.

    Article  PubMed  Google Scholar 

  44. Robbins MS, et al. Headache, neurology in clinical practice. (2013);6164–73.

  45. Bussone G. Strictly unilateral headaches: considerations of a clinician. Neurol Sci. 2014;35 Suppl 1:71–5.

    Article  PubMed  Google Scholar 

  46. May A. Pearls and pitfalls: neuroimaging in headache. Cephalalgia. 2013;33(8):554–65. This article is a very recent review that summarizes how important neuroimaging is in understanding headache pathophysiology and touches on new developments in advanced neuroimaging in primary headache disorders.

    Article  PubMed  Google Scholar 

  47. Naegel S, Holle D, Obermann M. Structural imaging in cluster headache. Curr Pain Headache Rep. 2014;18(5):415.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Deena E. Kuruvilla declares no potential conflicts of interest. Dr. Richard B. Lipton receives research support from the NIH: PO1 AG003949 (Program Director), PO1AG027734 (Project Leader), RO1AG025119 (Investigator), RO1AG022374-06A2 (Investigator), RO1AG034119 (Investigator), RO1AG12101 (Investigator), K23AG030857 (Mentor), K23NS05140901A1 (Mentor), and K23NS47256 (Mentor), the National Headache Foundation, and the Migraine Research Fund; serves on the editorial board of Neurology and Cephalalgia and as senior advisor to Headache, has reviewed for the NIA and NINDS, holds stock options in eNeura Therapeutics (a company without commercial products); serves as consultant, advisory board member, or has received honoraria from: Alder, Allergan, American Headache Society, Autonomic Technologies, Boston Scientific, Bristol Myers Squibb, Colucid, Dr. Reddy’s, Electrocore, Eli Lilly, Endo, eNeura Therapeutics, Informa, Labrys, Merck, Novartis, Teva, and Vedanta.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Neurology and Headache and Facial Pain, School of Medicine, Yale University, 800 Howard Ave, LL, New Haven, CT, 06519, USA

    Deena E. Kuruvilla

  2. Albert Einstein College of Medicine and the Montefiore Headache Center, 1165 Morris park avenue, room 332, Bronx, NY, 10461, USA

    Richard B. Lipton

Authors
  1. Deena E. Kuruvilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard B. Lipton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard B. Lipton.

Additional information

This article is part of the Topical Collection on Imaging

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kuruvilla, D.E., Lipton, R.B. Appropriate Use of Neuroimaging in Headache. Curr Pain Headache Rep 19, 17 (2015). https://doi.org/10.1007/s11916-015-0490-3

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11916-015-0490-3

Keywords

Search

Navigation