The role of cranial computed tomography in the diagnostic work-up of headache

Approximately 18% of all patients referred for a cranial computed tomography complain of headache only. We reviewed 363 consecutive patients in order to assess the value of this examination in the diagnostic approach. Despite the vast number of normal examinations (88.4%), we advocate the routine use of a cranial computed tomography in every patient with chronic headache. The cost of the examination can significantly be reduced by performing an unenhanced scan only. An additional contrast-enhanced scan should be obtained if a suspicious lesion is seen. Brain magnetic resonance imaging is not indicated except in the preoperative workup of a lesion visualized on computed tomography.