New Guidelines on Headache Imaging.

[Argirios Argiriou]

January 8, 2020

New Guidelines on Headache Imaging
Stephanie J. Nahas, MD reviewing Whitehead MT et al. J Am Coll Radiol 2019 Nov

A multidisciplinary expert panel provides headache imaging guidelines, updated from 2014.

Sponsoring Organization: American College of Radiology

Background and Objective

A multidisciplinary expert panel provides an updated, evidence-based consensus and rationale for initial imaging studies in common headache presentations in adults.

Key Points

For thunderclap headache, computed tomographic (CT) imaging of the head (CTH) without contrast remains the most appropriate, although CT arteriogram may be appropriate in certain circumstances.

For new headache with optic disc edema, magnetic resonance (MR) imaging of the brain (MRIB) with or without contrast or CTH without contrast are usually appropriate, while CTH with contrast and CT or MR venography may be appropriate.

New or progressive headache with “red flags” (e.g., subacute head trauma, exertional headache, neurologic deficit, cancer, immunocompromise, pregnancy, age ≥50) warrants plain CTH or MRIB with or without contrast.

New primary headache of suspected trigeminal autonomic origin (e.g., cluster headache) should be investigated with MRIB, contrast recommended.

For chronic headache with new features or progression, MRIB with or without contrast is appropriate (CTH with or without contrast may be appropriate).

Imaging is not appropriate for newly diagnosed migraine or tension-type headache with a normal neurologic exam or for chronic stable headache with no neurologic deficit.

COMMENT

In most cases, neuroimaging for headache is unnecessary, but when it is, knowing which study to order is crucial. Improvements over previous criteria include a new umbrella “red flags” scenario, clarity that these criteria are for initial imaging only, and new references to additional criteria when secondary etiologies or contributors are present or suspected (e.g., stroke, sinonasal disease). Further, the addition of the most common scenario, primary migraine or tension-type headache without neurologic deficit, for which imaging is not appropriate, will help reinforce that in most cases, investigation is unnecessary beyond a careful taking of the history.

Dr. Nahas is Director, Headache Medicine Fellowship Program and Associate Professor, Department of Neurology, Thomas Jefferson University Jefferson Headache Center, Philadelphia.

CITATION(S):
Whitehead MT et al. for the Expert Panel on Neurologic Imaging. ACR Appropriateness Criteria® headache. J Am Coll Radiol 2019 Nov; 16:S364. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος