Neuroimaging clinics of North America
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Headaches are exceedingly common, but most individuals who seek medical attention with headache will not have a serious underlying etiology such as a brain tumor. Brain tumors are uncommon; however, many patients with brain tumors do suffer from headaches. Generally these headaches are accompanied by other neurologic signs and symptoms. A careful clinical assessment for red flags should be undertaken when considering further work-up with neuroimaging to exclude a serious underlying condition.
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Neuroimaging Clin. N. Am. · May 2019
ReviewAdvanced Imaging in the Evaluation of Migraine Headaches.
The use of advanced imaging in routine diagnostic practice appears to provide only limited value in patients with migraine who have not experienced recent changes in headache characteristics or symptoms. However, advanced imaging may have potential for studying the biological manifestations and pathophysiology of migraine headaches. Migraine with aura appears to have characteristic spatiotemporal changes in structural anatomy, function, hemodynamics, metabolism, and biochemistry, whereas migraine without aura produces more subtle and complex changes. Large, controlled, multicenter imaging-based observational trials are needed to confirm the anecdotal evidence in the literature and test the scientific hypotheses thought to underscore migraine pathophysiology.
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Headaches and sinus disease are common reasons to seek medical care, with marked worldwide prevalence and large socioeconomic burdens. Headaches caused by sinus diseases are rare; many "rhinogenic headaches" are actually migraines. The similar symptoms may result from autonomic dysfunction and trigeminovascular pathways. Using the mnemonic ACHE, this article presents key Anatomy, Clinical cases, How to image, Essential clinical and radiographic features that help the radiologist, otolaryngologist, and neurologist evaluate sinus disease and headaches.
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Headache is a common symptom in patients with Chiari I malformation (CMI), characterized by 5 mm or greater cerebellar tonsillar herniation below foramen magnum. Radiologists should be aware of the different types of headaches reported by CMI patients and which headache patterns are distinctive features of the diagnosis. A methodical imaging strategy is required to fully assess a CMI patient to exclude secondary causes of tonsillar herniation such as intracranial hypotension or associated conditions such as syrinx. Both anatomic and physiologic imaging can help determine if headaches are CMI associated, and assist clinicians in therapeutic decision making.