Clinical condition—Headache

CT, head, without contrastCT, head, without and with contrastMR imaging, brain, without and with contrastMR imaging, brain, without contrastMR angiography, head, with or without contrastCT angiogram, headAngiography, cerebralMR angiography, head and neck, with or without contrastCT angiogram, head and neck
Worsened chronic headache. History of headache.4444222XX
Sudden onset of severe headache (“Worst headache of one's life, thunderclap headache”).966a7a887XX
Sudden onset of unilateral headache, or suspected carotid or vertebral dissection or ipsilateral Horner syndrome.o868b8bXX78c8c
Headache, suspected complication of sinusitis and/or mastoiditis.p7d6d87XXXXX
New headache in patient older than age 60. Sedimentation rate higher than 55, temporal tenderness. Suspected temporal arteritis.657c8cXX4e55
New headache in HIV+ individual.6f5883g3g2eXX
New headache in pregnant patient.q8X5h85i2jXXX
New headache. Suspected meningitis/encephalitis.8k6l86m6i3nXXX

  • Note:—Appropriateness criteria scale from 1 to 9, 1–least appropriate, 9–most appropriate;

  • a , may be helpful after CT depending on CT findings;

  • b , with diffusion-weighted sequences;

  • c , usage of CT versus MR imaging depends on local preference and availability;

  • d , include sinuses;

  • e , if noninvasive imaging unrewarding;

  • f , if MR imaging not available;

  • g , if vascular lesion suspected;

  • h , pregnancy is a relative contraindication to gadolinium administration, reserve for urgent medical emergency;

  • i , MR venography (MRV) should also be performed;

  • j , if MR imaging not available, contraindicated or inconclusive;

  • k , to exclude intracranial pressure changes;

  • l , MR imaging preferable, depending on availability;

  • m , needs contrast;

  • n , useful for problem solving or if there is a strong suspicion of vascular disease;

  • o , US, neck (carotid duplex) rating of 3;

  • p , x-ray skull rating of 4;

  • q , CT, head, with contrast rating of 3.