MRI in headache

Abstract

Headaches are described as primary, where no contributing cause is found, or secondary, where a discrete lesion or other condition has triggered the phenotype. Primary headache is a common condition; migraine causes much of the morbidity in this population, at great personal and economic cost. The decision to use MRI is a common dilemma facing clinicians, particularly as primary headache phenotypes can be triggered by secondary causes. Studies demonstrate that there is no appreciable difference in the frequency of pathological and incidental findings in common headache populations compared with the general community. Imaging is therefore not routinely required where a primary headache diagnosis can be made. Clinicians must be aware of the risk of manufacturing morbidity in uncovering incidental and nonsignificant imaging changes. However, patients demonstrating ‘red flags’ on medical history and examination do require imaging to help exclude a secondary cause of symptoms. Other headache phenotypes, such as the trigeminal autonomic cephalalgias, also generally require MRI.

Keywords::

• migraine
• MRI
• trigeminal autonomic cephalalgias

Financial & competing interests disclosure

PJ Goadsby is on the boards of Allergan, Colucid, MAP Pharmaceuticals, Merck Sharpe & Dohme Ltd, eNeura, Neuroaxon, Autonomic Technologies Inc, Boston Scientific, Eli Lilly, Medtronic, Linde Gases, Arteaus, AlderBio and Bristol-Myers Squibb. He has consulted for Gammacore, Pfizer, Nevrocorp, Lundbeck, Zogenix, Impax and Dr.Reddy’s, and has been compensated for expert legal testimony. He receives grant support from GlaxoSmithKline, MAP, MSD, eNeura, and Amgen. He has received honoraria for speaking from MSD, Pfizer, Allergan, and Mennarini, and payment for editorial work from Journal Watch Neurology and for developing educational materials for the American Headache Society. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

Adapted from [9].

Adapted with permission from [57].