Imaging in the evaluation of headache

Area of Science:

• Neurology
• Radiology
• Diagnostic Imaging

Background:

• Headaches are common, with most being primary disorders.
• Secondary causes of headache can be life-threatening or cause severe morbidity.
• Diagnostic imaging plays a role in excluding secondary causes.

Purpose of the Study:

• To evaluate the role and decision-making factors for neuroimaging in headache diagnosis.
• To highlight the importance of considering pretest probability and imaging sensitivity.
• To discuss the value of negative imaging in cost-benefit analyses.

Main Methods:

• Review of diagnostic criteria (e.g., ICHD-2) for headache.
• Analysis of factors influencing the decision to image headache patients.
• Discussion of existing and emerging neuroimaging techniques (e.g., fMRI, MRS).

Main Results:

• Imaging is indicated when headache characteristics don't fit primary types, to exclude secondary causes.
• The value of negative imaging in cost-benefit analysis is often underestimated.
• Yield of neuroimaging for significant intracranial findings is low in patients without focal neurological deficits, but higher in specific subgroups.

Conclusions:

• Neuroimaging is essential for excluding serious secondary headache causes.
• Careful consideration of clinical factors improves the utility of headache imaging.
• Further research is needed to refine imaging decision-making and assess its impact on patient outcomes.