Using imaging to diagnose headache

Neuroimaging for headaches

Practice points on headache

  • Headache is common but usually benign
  • Neuroimaging is not usually needed unless a red flag is present
  • Neuroimaging is unlikely to show cause of primary headache and can lead to incidental findings
  • Consider neuroimaging for people whose history and physical /neurological examinations suggest that their headache may be secondary to a serious cause

Headache is common. Global 1-year prevalence data show that about 1 in 2 people will suffer a headache: 4 in 10 of these will have a tension-type headache and 1 in 10 will have a migraine. These people are likely to have normal examinations and are unlikely to have any red flag symptoms and signs. However, ’red flag‘ symptoms and signs identified from taking a comprehensive history and conducting careful physical and neurological examination, indicate the need for investigation, such as neuroimaging (e.g. computed tomography [CT] scan or magnetic resonance imaging [MRI]).

Neuroimaging

Neuroimaging is usually not needed unless a red flag is present and involves a consideration of risks and costs. These include risks of the procedure (e.g. exposure to ionising radiation or contrast media), risks related to interpreting the results (e.g. incidental findings, false positives/negatives), and both financial and logistic costs (e.g. out-of-pocket expenses to the individual, cost to the health system, waiting time, transport to and from the imaging facility).

Patient resources

NPS MedicineWise has developed a headache diary which GPs can provide to patients suffering from frequent headaches to assist in identification of potential triggers and better headache management.

Find out more

NPS News 79 focuses on headache diagnosis and the role of neuroimaging, management of headache and prevention (including non-drug strategies).

Practice Review 59 practical advice and the supporting evidence for health professionals about the role of a detailed history and targeted examination in diagnosing headache.