CT or MRI preferred for the evaluation of headache

CT or MRI preferred for the evaluation of headache

Which imaging modality CT or MRI is the preferred neuroimaging for the evaluation of headache? 

When available, MRI is the preferred study for the evaluation for headaches. CT is preferable in acute situations such as head trauma, acute headache to rule out subarachnoid hemorrhage, as well as in patients with contraindications to MRI.

The below causes of headache can be missed on a routine CT scan of the head:

  • vascular disease (saccular aneurysms, arteriovenous malformations—especially posterior fossa)
  • subarachnoid hemorrhage
  • carotid or vertebral artery dissections
  • infarcts
  • cerebral venous thrombosis
  • vasculitis (white matter abnormalities
  • cerebral vasospasm
  • subdural and epidural hematomas
  • neoplastic disease (neoplasms especially in the posterior fossa, meningeal metastases, and pituitary tumor and hemorrhage)
  • cervicomedullary lesions (Chiari malformations and foramen magnum meningioma)
  • infections (paranasal sinusitis, meningoencephalitis, cerebritis, and brain abscess)
  • low cerebrospinal fluid (CSF) pressure syndrome

CT of the head also exposes the patient to ionizing radiation (2 mSv without contrast) where there may be a delayed increased risk for various cancers with a greater potential for younger people 

Seek Additional Information

www.xrayrisk.com

Sources

Headache Classification Committee of the International Headache Society (IHS): The International Classification of Headache Disorders, 3rd edition (beta version), Cephalalgia 33(9):629-808, 2013. 

Evans RW: Diagnostic testing for migraines and other primary headaches. Neurol Clin 27:393-415, 2009.

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