MRI in Headache

Data taken from [19].

Data taken from [24].

Authors and Disclosures

Michael Eller and Peter J Goadsby*

Headache Group – Department of Neurology, University of California, San Francisco, CA, USA

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.

*Author for correspondence
pgoadsby@headache.ucsf.edu

Sidebar

Key Issues

• Headache is a common complaint within the general community.

• The decision to image in headache disorders is a frequent clinical dilemma.

• The frequency of pathological and incidental changes with MRI is not demonstrably different in primary headache patients compared with the general population.

• Deep white matter MRI changes, seen in migraineur subpopulations in some studies, are unlikely to be clinically relevant for individual patients.

• Some headache phenotypes require imaging, such as the trigeminal autonomic cephalalgias.

• The presence of red flags in medical history or examination, or both, suggest the requirement for imaging.

• Clinicians should be aware of some rare headache conditions with characteristic changes on imaging.