Archive for August 13th, 2014

August 13, 2014

Headaches and Head Issues #1: When NOT To Image

headache by Pierre Willemin via Flickr Copyright Creative Commons Attribution-NoDerivs 2.0 Generic (CC BY-ND 2.0)Headaches are a common complaint and come in different forms. Most headaches, though they may not feel like “nothing” at the time, are often simple and solvable problems.


As radiologists we have a special role when it comes to headaches. Ready for this? Most times patients with headaches need not visit their friendly radiologists. The brain (and even the musculature around it) is a complex and honestly beautiful thing. We are advocates of imaging carefully – and there are times when that means no imaging at all.


The crux is this: it can be hard to know when a headache should prompt medical evaluation. Rules have been developed helping medical professionals determine when imaging will be most beneficial. if a headache has other symptoms associated with it (such as nausea or vomiting) or is new, significantly worse or comes on suddenly, medical evaluation is warranted and imaging may be needed.


According to a recent article published in the Journal of the American College of Radiology:


“Most patients presenting with uncomplicated, nontraumatic, primary headache do not require imaging. When history, physical, or neurologic examination elicits “red flags” or critical features of the headache, then further investigation with imaging may be warranted to exclude a secondary cause.”


What are the “red flags” that mean imaging may be necessary?



  • history of head trauma;
  • new, worse, or abrupt onset headache;
  • thunderclap headache;
  • headache with pain radiating to the neck;
  • one sided headache with facial pain;
  • persistent and positional headaches;
  • headache centered at side of head (temple) in older individuals.



It’s important to not ignore intuition. If something about your headache is unusual, or the circumstances predicating it are new, it is definitely worth seeing your doctor. However, if s/he doesn’t opt for imaging in the initial stages, that may be perfectly okay too. We love seeing our patients on the road to their best possible health!



(Image credit: headache by Pierre Willemin via Flickr Copyright Creative Commons Attribution-NoDerivs 2.0 Generic (CC BY-ND 2.0))



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