However, as it is so sensitive, there are often abnormal findings unrelated to the headache that may lead to further testing. The most common abnormalities are small spots in the brain that may be mistaken for Multiple Sclerosis. Bottom Line: If you have migraine, which is often a severe and disabling headache, you do not need to have a CT or MRI, and can rest assured that the likelihood of having a serious abnormality in the brain is probably no different from your next-door neighbor who does not have migraine.
If however, you are suffering from new headaches, headaches that are increasing in frequency and intensity, or have a major change in your headache pattern; make an appointment to discuss this with your care provider. Skip to content.
When is it considered medically necessary to have a brain imaging study? When there are significant findings on the physical examination such as: swelling of the optic nerve abnormal reflexes weakness on one side of the face or body unsteady gait double vision vision loss abnormalities of the pupils confusion In certain situations such as: new headache in a person with cancer headaches in people who are immunosuppressed headaches that are becoming worse new headache in people over age 50 no better with prescribed medicine persistent headache after head injury.
In people who meet the criteria of migraine, have no abnormal findings on examination, and who have not had a significant change in the headache pattern DO NOT need to have an imaging study. This was first stated in as part of an imaging guideline by the American Academy of Neurology, and has been adopted as an evidence based guideline.
This has been restated in the Choosing Wisely guideline in here. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life.
Approach to acute headache in adults. Am Fam Physician. Holle D, Obermann M. The role of neuroimaging in the diagnosis of headache disorders. Ther Adv Neurol Disord. Your Privacy Rights. To change or withdraw your consent choices for VerywellHealth. At any time, you can update your settings through the "EU Privacy" link at the bottom of any page. These choices will be signaled globally to our partners and will not affect browsing data.
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What are your concerns? Instead of taking the default option of ordering neuroimaging, clinicians are advised to first examine patient history and physical findings, looking for red flags that may require further examination.
Most diagnosed headaches tend to be primary, so clinicians look for clues that may indicate a more serious secondary headache. Even when red flags are identified, some secondary headaches, such as headaches caused by sinusitis, can be easily diagnosed without neuroimaging.
MRIs, CT scans, EEGs, and other neuroimaging techniques have facilitated a greater understanding of the human brain and neurologic disorders.
However, there are certain risks involved in the use of neuroimaging. When brain scans are not carried out effectively, there is the risk of providing inaccurate information to patients, leaving them unnecessarily worried or underconcerned, depending on the situation.
The accuracy of the scan often depends on the quality of the imaging machine and the expertise of the operator. Even with the right conditions, false or misleading results may still occur. Exposure to radiation, allergic reaction to mediums, and necessary sedation for patients who feel claustrophobic can also lead to further complications.
Although neuroimaging can be a cost-effective method of diagnosing life-threatening illnesses, overuse in headache disorders is driving up costs for both patients and healthcare providers.
A physician should not diagnose NDPH until ruling out other organic causes such as sphenoid sinusitis, neoplasms, and chronic meningitis. In some cases, no other tests are required. CT angiography can be better than magnetic resonance angiography MRA if the physician is looking for intracranial aneurysm or carotid dissection, said Dr.
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