Often, patients will arrive at the emergency department with headaches that leave them crippled with pain and concerned that it is a serious health issue. Although there are symptoms that physicians check for to indicate the severity of the ailment, they may jump to medical imaging exams as a viable solution.
However, according to an article published in the Journal of the American College of Radiology, uncomplicated and primary headaches do not require imaging scans for definitive diagnoses, Diagnostic Imaging reported. Using the ACR's Appropriateness Criteria, the organization's authors – led by Annette Douglas, M.D., and Franz Wippold, M.D. – explained that, while general head pain does not necessarily constitute imaging, certain red flags may suggest further examination with CT or MRI.
"Several studies have confirmed the low yield of imaging procedures for individuals presenting with isolated headache, i.e., headache unaccompanied by other neurological findings," wrote the authors, quoted by the news source. "Therefore, when considering a common disorder, such as headache, indications for imaging become relevant."
While physicians can conduct physical examinations to determine symptomatic behavior of acute headaches, there are red flags that can narrow down their treatment options. These include:
- Headache associated with trauma
- Abrupt onset of pain
- Discomfort radiating to the neck
- Persistent and positional pain
- Temporal pain in older patients
However, there are certain patients who may benefit from imaging, such as:
- Pregnant women
- Cancer patients
- Individuals with systemic illnesses, including hypercoagulable disorders
- Headaches associated with exertions or sexual activity
ABIM offers insight for headache imaging
The ACR is not alone in supplying information to doctors on appropriate imaging protocols for patients with headaches. Choosing Wisely, an initiative of the American Board of Internal Medicine, seeks to educate radiologists and other digital imaging experts on the proper guidelines for ordering CT and MRI scans for severe head pain.
A major complication of ordering scans, beyond the associated costs to patients and care centers, is that they can show something that appears to be dangerous but, in actuality, is not. Minor twists in a blood vessel may lead to a false positive diagnosis of an aneurysm, while a prominent area of the brain may be mistaken for a malignant tumor. As a result, these risks could lead to increased anxiety, extensive and unnecessary follow-up exams, and expensive consultations with neurology specialists.
In order to avoid overuse of equipment that could prove costly for everyone involved, radiologists should follow the guidelines provided by the ACR and ABIM.