[Imaging in the evaluation of headaches]

Area of Science:

• Neurology
• Radiology
• Primary Care Medicine

Context:

• Headache is a frequent primary care presentation.
• Most headaches are benign and do not require advanced diagnostics.
• Red flag symptoms necessitate further investigation.

Purpose:

• To outline the diagnostic approach for headaches in primary care.
• To delineate the appropriate use of brain imaging (CT and MRI) in headache evaluation.
• To differentiate imaging modalities based on clinical suspicion and setting.

Summary:

• A head CT scan with and without contrast is the primary imaging choice for acute headache evaluation, especially with red flags, to identify intracranial lesions or bleeding.
• Magnetic Resonance Imaging (MRI) offers higher sensitivity and is preferred for outpatient investigation and monitoring of suspected intracranial tumors or infections.
• The diagnostic pathway hinges on suspected etiology and urgency, guiding the selection of neuroimaging.

Impact:

• Provides clear guidance for primary care physicians on headache workup.
• Optimizes the use of neuroimaging resources in headache management.
• Facilitates timely diagnosis and appropriate management of potentially serious headache causes.