Investigating severe headache (summary)
Citation, DOI, disclosures and article data
At the time the article was created Derek Smith had no recorded disclosures.View Derek Smith's current disclosures
At the time the article was last revised Henry Knipe had the following disclosures:
- Integral Diagnostics, Shareholder (ongoing)
- Micro-X Ltd, Shareholder (ongoing)
These were assessed during peer review and were determined to not be relevant to the changes that were made.View Henry Knipe's current disclosures
This is a basic article for medical students and other non-radiologists
Investigating severe headache (cephalgia is the rarely used medical term for headache 5) is a common requirement in both acute and emergency services. It is also common in neurology clinics and GP surgeries. While many of the headaches are benign a large number of patients require radiological investigation 1,2.
Worldwide, the commonest headaches are tension-type headaches and migraines (90%) 1. The history of tension headaches and migraines are typical and they are usually not accompanied by physical findings.
This is a summary article; we do not have a more in-depth reference article.
are there any red flags? 3
new, different or "worst ever" headache
altered neurology: paralysis, ataxia, abnormal pupillary response
early morning headaches or postural changes
confusion or drowsiness
new headaches in those over 50 years old
are the headaches acute, how long have the headaches been there, how long do they last, are they progressive?
where is the pain worst?
are they positional (standing/lying/moving)?
is there aura (photophobia/phonophobia/nausea)?
is there neck stiffness or fever?
cranial nerve examination
focal signs may suggest the location of pathology
fundoscopy may confirm papilledema which is suggestive of raised intracranial pressure
visual field assessment
used in the emergency/acute setting
will show hemorrhage/tumor
if subarachnoid hemorrhage, CT angiogram can be performed
when available, used for assessment of chronic symptoms
MR venogram if sinus thrombosis is suspected 4
making the request
know what question you are trying to answer
are there any red flags?
what is the acuity of onset?
how urgently does this need to be investigated?