Answer
A neuroimaging study typically is not necessary in adults with a chronic (>6mo) history of headaches, normal neurologic examination findings, and no seizures.
Studies have shown that children with a history consistent with migraine and normal neurologic examination findings will not have clinically significant abnormalities on head computed tomography (CT) or cranial MRI scans. [16] A small percentage of migrainous children may have incidental and unrelated findings, but routine neuroimaging is not necessary in juvenile migraine patients. However, children with chronic, progressive headaches or those younger than 4 years probably should have a cranial MRI.
Consider an imaging study in patients with a history of seizures, recent head trauma, significant change in the headache, or evidence of focal neurologic deficits or papilledema upon physical examination. No absolute rules exist in the evaluation of the headache patient; the need for a neuroimaging study ultimately is based on clinical judgment.
