Imaging Tests For Headaches: When You Need Them And When You Dont
CT and MRI examinations are called imaging tests because they take pictures, or images, of the inside of the body. Many people who have headaches want a CT scan or an MRI to find out if their headaches are caused by a serious problem, such as a brain tumor. Most of the time these tests are not needed. Heres why:
Imaging tests rarely help.
Health care providers see many patients for headaches and most of them have migraines or headaches caused by tension. Both kinds of headaches can be very painful, but a CT scan or an MRI rarely shows why the headache occurs. Having a CT scan or MRI also does not help ease the pain.
A health care provider can diagnose most headaches during an office visit. The health care provider asks you questions about your health and your symptoms. This is called a medical history. Then the health care provider may do what is called a neurological exam, which includes a test of your reflexes. If your medical history and exam are normal, usually imaging tests will not show a serious problem.
Imaging tests have risks.
A CT scan of the head uses a low radiation dose. This may slightly increase the risk of harmful effects such as cancer. Risks from radiation exposure may add up, so it is best to avoid unnecessary radiation.
The results of your CT scan or an MRI may also be unclear. This can lead to more tests and even treatment that you do not need.
When should you have an imaging test for headaches?
How to treat a headache
If you have migraines:
The Doctor Or Nurse Practitioner May Order A Test If Your Child Has:
- Sudden, worst headache of his or her life
- Sudden change in headache quality or pattern
- Headache often beginning during sleep
- Seizure with headache
- Headache that started with a high fever or severe illness and is getting worse
- Recent, severe head injury with headache
- Headache triggered by exercise, certain positions or strain during coughing, sneezing or toileting
- Worrisome symptoms with headache
- Headaches that begin in the back of the head and have other characteristics listed above.
Your provider will help decide what testing is right for your child. There is no lab test or imaging that proves a migraine diagnosis. Blood work and imaging are usually normal.
What Happens During The Test
- As it begins, you’ll hear the equipment making a muffled thumping sound that will last for several minutes. Other than the sound, you shouldnât feel anything unusual during the scanning.
- For some MRI exams, you’ll need a shot of a “contrast material” into your vein. It helps doctors see certain structures in your brain on the scan images.
- Feel free to ask questions. Tell the person giving you the test or the doctor if you have any concerns.
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How Are Headaches Treated
Provided one of the serious conditions noted above is not present, relatively simple treatment options can be considered. To treat symptoms and prevent the frequency and severity of headaches, physicians may try to identify headache “triggers,” such as stress or certain foods, and recommend treatment options including:
- preventive medications and treatments.
- lifestyle changes, including stress management and relaxation techniques.
- pain-relieving medication, such as acetaminophen or ibuprofen. Children and adolescents should avoid taking aspirin. In rare cases, aspirin can cause Reye Syndrome, a serious and potentially fatal condition.
If your headache is the result of an underlying medical condition or injury, your physician will discuss treatment options with you.
Headache Plus Other Symptoms Or Signs
Sometimes it’s the symptoms associated with your headache that warrant neuroimagingwhich could mean either a CT scan or an MRI, or both.
These associated symptoms or signs include:
- Neurological symptoms other than those found in a typical migraine aura
- Neck stiffness, fever, or other whole-body symptoms like a rash
- A headache triggered by a cough, strenuous exercise, or sex
- A headache with a history of dizziness or balance problems
- A headache that occurs after a head trauma
- A finding of papilledema on physical exam
A Word From Verywell
It is important to remember that, in most cases, brain imaging is not indicated for a headache or migraine diagnosis. Most headaches are simply thatjust a headache, a benign medical problem.
That being said, it is important to see a healthcare provider for your headache evaluation. It can be challenging distinguishing what is serious and what is notand sometimes it’s the small medical nuances a healthcare provider picks up that clinch the diagnosis.
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When Should You Get A Ct Scan For Migraines
You may also need a CT scan or an MRI if you have unusual headaches. See your health care provider right away if: You suddenly develop a very severe headache which feels like something is bursting inside your head. Your headaches are different from other headaches youve had, especially if you are age 50 or older.
When Would An Mri Ct Or Eeg Be The Right Test For My Child
When we look for physical causes, we do certain tests. Imaging of the head is a medical way to take pictures, or images, of the brain. There are several types of imaging. The two tests used the most for headache are a CT scan and an MRI .
An MRI shows better detail than a CT scan. An MRI does not expose the child to radiation. An MRI can take over an hour to complete. Some children may require sedation or anesthesia to be still that long. In an emergency, CT scans are readily available and can be performed quickly. Some children have other health problems that may keep them from having an MRI, while a CT would be safe.
We do not recommend an EEG as part of the headache evaluation. This test looks for abnormal brain waves. It is useful if seizures are suspected. It is not a useful test for a regular headache.
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Who Should Get A Ct Scan And When
A doctor may recommend a CT scan if they suspect there may be an underlying medical condition triggering a persons headache. Specifically, they may recommend a head CT scan if a person experiences one or more of the following:
- headache pain that is sudden or severe, or accompanied by a feeling of something bursting inside the head
- headache pain that differs from a persons usual headache pain, particularly if the person is aged 50 years or above
- headaches that occur after physical activity
- headaches accompanied by additional symptoms, such as:
Are There Negative Consequences Of Unwarranted Imaging
While imaging more than needed may seem safer and benign, its not. Here are some negative consequences of unnecessary imaging:
- Exposure to radiation
- Costs to you and society
- Longer delays for people who really need imaging
- Findings that may cause undue anxiety and lead to more useless imaging to «control» the lesion
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What Test Will Show A Torn Muscle
An MRI is the best type of imaging for looking at tissue.
Your physician may order an MRI on the damaged muscle to find or learn more about your injury.
This type of muscle tear imaging can pinpoint the location of even the smallest muscle strains and determine whether a partial or complete strain has occurred..
When To Order Neuroimaging With Contrast
Gadolinium-containing contrast agents are often used in MRI to enhance the quality of images . Care is needed in patients with impaired renal function to avoid the rare, but serious adverse effect of nephrogenic systemic fibrosis. Headache patients that require MRI with gadolinium include: patients with abnormal neurologic examination, positional headaches, exertional or valsalva maneuver-exacerbated headaches, cluster or neuralgia-type headaches or facial pain, and known history of cancer, AIDS, immunocompromised, or infectious disease .
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What Happens During The Ct Scan
- If you get a shot of contrast material, you may feel flushed, or you may have a metallic taste in your mouth. These are common reactions. If you have shortness of breath or any unusual symptoms, tell the person who’s giving you the test — the technologist.
- The technologist will help you lie in the correct position on the examining table. The table will then automatically move into place for imaging. Itâs very important that you lie as still as possible during the procedure. Movement could blur the images.
- The technicians may ask you to hold your breath briefly at some points when they’re taking the X-ray images.
When Is It Not Medically Necessary To Have A Brain Imaging Study
As headache is such a common problem, primary care providers see the clear majority of sufferers and make decisions about evaluation and treatment. They often refer to neurologists in more difficult or unusual cases. Many doctors bow to patient pressure to obtain a scan, and many practice defensive medicine and order a scan despite the guidelines. If a scan is ordered to evaluate a headache disorder, MRI with contrast is preferred as it is a more sensitive test than CT and does not involve any radiation. However, as it is so sensitive, there are often abnormal findings unrelated to the headache that may lead to further testing. The most common abnormalities are small spots in the brain that may be mistaken for Multiple Sclerosis. These spots are seen in up to 30% of all migraine patients, and are usually an incidental finding with no clinical significance.
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Migraine Headache Diagnosed With Head Ct Scan
Most of us have suffered from headachesat certain points in our lives. However, these conditions have comeand gone, disappearing shortly and being mild in terms of pain anddiscomfort. Therefore, headaches are not considered to be a serioushealth problem unless they become recurring, extremely painful or,simply, persistent enough to affect one’s daily functioning.
We usually experience headaches once weget exposed to excessive stress or diseases such as common cold orflu. These occurrences commonly result in a dull pain appearing inthe front, on the top or at the sides of the head. Unfortunately, some people are not solucky. Namely, their headaches are much more complicated due to thefact that they are suffering from migraines.
What is Migraine Headache?
Migraine headaches are considered to berecurrent headaches which take place hand-in-hand with some othersymptoms. The pain present during migraines is much more serious thatthat related to regular headaches. Also, migraines appear withcertain symptoms such as dizziness, nausea, photosensitivity or harshreactions to loud noises and strong smells.
When a person experiences a migraineattack, he/she is most commonly unable to function correctly. Thus,children may even skip school and adults may call in sick due tomigraines. Taking into consideration that about 10% of all Americanstudents suffer from migraines, the number of absences from schooldue to this factor can be quite big.
How Does A Ct Scan Cat Scan For Migraine Work
In some scans, contrast dye is injected intravenously, through an IV to make the inside of the body easier to see.
The patient lies on a narrow table with their head in a special cradle to help keep it still. The CT scanner will be near the head and is shaped like a large donut. The scanner will move around the head to take pictures of various angles as the table slowly slides in the direction of the donut-shaped scanner. As the scanner moves it makes clicking and buzzing sounds. You must be very still during the exam – and may be asked to hold your breath – because any movement may make the images blurry.
A computer guides the machine to take several x-rays of different angles of the brain.
If you may be pregnant, you must let your doctor know because the high amount of radiation in the CT Scan may harm a developing baby.
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Which Is More Accurate Ct Scan Or Mri
Both MRIs and CT scans can view internal body structures. However, a CT scan is faster and can provide pictures of tissues, organs, and skeletal structure. An MRI is highly adept at capturing images that help doctors determine if there are abnormal tissues within the body. MRIs are more detailed in their images.
Proper Diagnosis Of Your Symptoms Can:
- Give reassurance that the headaches or other symptoms are not a sign of a very serious illness
- Allow you to get advice on stopping, managing and treating your symptoms.
If other medical conditions co-exist alongside your migraine this is important in terms of treatment. Certain drugs cannot be taken together for example.
A confirmed diagnosis of migraine and appropriate treatment can help prevent some attacks from occurring and help you to control the remaining attacks more effectively.
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What Does A Vascular Headache Feel Like
Vascular headache is a group of conditions that involve the dilation or swelling of blood vessels that cause headache pain.
The blood vessels in the head become enlarged, distended and inflamed, which alters the normal pulsation of the vessels and leads to a throbbing pain that usually worsens with physical activity..
Headaches: Imaging Appropriateness Criteria
Headaches are a common complaint among patients, with many caused by tension or chronic migraines. Many headaches can be clinically diagnosed through imaging. Details on the most appropriate imaging exam to order based on suspected diagnosis or symptom, as well as red flags that necessitate ordering imaging, are below.
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Preparations Needed For A Ct Scan
There are some preparations that need to be done before the CT scan test. They are as follows:
- You should not eat anything 4 hours before the test
- Do not skip any regular medications. Keep taking them in consultation with your doctor
- Usually the CT scan takes 15-60 minutes, depending on the individual and the complexity of the problem. Be prepared likewise.
- If you have any doubts or fears, ask your doctor in advance.
Headache In People Older Than 50 With Suspected Giant Cell Arteritis
Giant cell arteritis causes inflammation of certain large and medium-sized blood vessels, typically branches of the external carotid artery .
This blood vessel inflammation may result in a variety of symptoms, but most notably a new headache , jaw pain when eating, and sometimes vision changes. Some people also develop a fever and feel unwell with a loss of appetite and generalized body aches.
In addition to an erythrocyte sedimentation rate or C-reactive protein blood test, a biopsy of the temporal artery and a high-resolution MRI are often ordered to confirm the diagnosis.
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Red Flags That Support Imaging For Headache:
Abnormal neurological examination .
Signs of systemic illness .
Worst headache ever.
Progression in frequency and severity of headaches.
New headache in patients older than 50 years.
Sudden onset of headache thunderclap headache.
New-onset headache in an immunocompromised or cancer patient.
Headache after head trauma.
Why Cant We See Migraine On A Scan Or Mri
Migraine is caused by inflammatory and electrical disturbances in the brains complicated network . All those phenomena happen at the microscopic scale and are therefore invisible for the eye. Migraine is a real neurological disease, but it cannot be seen on imaging studies .
As we learn more about migraine, this may change in the future but for now giving an accurate description of your symptoms is the most important way to help your doctor make a diagnosis.
Migraine is invisible on the MRI but very visible on a headache diary . Consider starting one!
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What Can A Ct Scan Detect In The Head
CT scanning of the head is typically used to detect: bleeding, brain injury and skull fractures in patients with head injuries. bleeding caused by a ruptured or leaking aneurysm in a patient with a sudden severe headache. a blood clot or bleeding within the brain shortly after a patient exhibits symptoms of a stroke.
When To See A Doctor
Headaches come in three varieties: Tension, sinus, and migraine. More than 95% of headaches arent caused by an underlying disease or structural abnormality. Instead, they spring from common conditions such as stress, fatigue, lack of sleep, hunger, changes in estrogen level, weather changes, or caffeine withdrawal. Most people dont need a doctor visit or a brain scan. Instead, they need over-the-counter pain relievers or prescription medications, rest, and relaxation.
If you find yourself taking painkillers for headaches more than a couple of times a week, see your doctor. Red flags that signal the need for medical evaluation include:
- Not having had headaches before
- Headaches that worsen over the course of a few weeks
- A headache that comes on fast
- Headache associated with fever
- Severe headache in an older person
- Headache associated with symptoms or signs like swelling in the back of the eyes
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