The radiology of headache

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Acute, severe headaches necessitate urgent diagnostic evaluation.
• Identifying the cause of headache is critical for appropriate management.
• Various imaging modalities play a role in diagnosing headache etiologies.

Purpose of the Study:

• To outline the diagnostic utility of CT and MRI in evaluating acute severe headaches.
• To differentiate the strengths of CT and MRI for specific neurological conditions.
• To highlight imaging findings for hemorrhage, hydrocephalus, vascular malformations, and trauma-related injuries.

Main Methods:

• Review of imaging findings in patients presenting with severe headaches.
• Comparison of computed tomography (CT) sensitivity for acute hemorrhage versus MRI.
• Evaluation of MRI's capability in characterizing vascular malformations, parenchymal lesions, and trauma sequelae.
• Assessment of tomography and MRI for temporomandibular joint dysfunction.

Main Results:

• CT is more sensitive than MRI for detecting acute intracranial hemorrhage.
• MRI provides superior characterization of vascular malformations, neoplastic, inflammatory, and congenital lesions.
• MRI effectively visualizes subacute subdural hematomas and evidence of shear injury, even when CT is equivocal.
• Both CT and MRI can detect acute hydrocephalus; conventional tomography and MRI are useful for temporomandibular joint dysfunction, with MRI excelling in soft tissue detail.

Conclusions:

• CT is the primary modality for initial evaluation of acute severe headache, particularly for hemorrhage.
• MRI is valuable for further characterization of diverse pathologies once the patient is stable.
• The choice of imaging modality depends on the clinical presentation and suspected underlying cause of headache.