Should I have imaging tests to evaluate my headaches?
Introduction
This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
Consider the following when making your decision:
- Most headaches are not caused by a serious medical condition. Even painful, recurring headaches, such as cluster, migraine, or tension headaches, are not caused by another serious condition (such as a brain tumor), and their cause will not show up on imaging tests.
- It is unusual to develop new, painful headaches after age 50. Imaging tests may help diagnose the cause of these types of headaches.
- Medicines often effectively control the pain of recurring headaches—such as tension, migraine, or cluster headaches—and imaging test results will not affect your treatment.
- If you have recurring headaches but medicines aren't working or your headaches have recently changed—for example, they have gotten worse, wake you up at night, or you've developed symptoms such as numbness or tingling—imaging tests may help diagnose or rule out any new problems.
- If you are concerned about the cause of your headaches and are losing sleep or feeling overwhelmed by fear, imaging test results may reassure you. But you will have to weigh the fear and worry against the high cost of these tests, especially if you do not have insurance or the financial resources to cover their cost.
Medical Information
What are headaches?
Almost everyone has an occasional headache. Most headaches, even very painful tension and migraine headaches, may be treated with common medicines, do not require prescription narcotic pain medicines, and are not life-threatening. The most common types of headaches may happen again and again and include:
- Cluster headaches, which cause debilitating pain during cycles or "clusters" of headaches that happen over a period of weeks to months.
- Migraine headaches, which cause throbbing pain usually on one side of the head. These headaches often occur with nausea, vomiting, and extreme sensitivity to light and sound and sometimes smells.
- Tension headaches, which cause aching pain and tightness around the forehead that may feel like a "vise grip."
What are the risks of having headaches?
Headaches are common. They are commonly caused by tension, but they can also be caused by eyestrain, a dental problem, or a sinus infection. Very few headaches are actually caused by a serious medical condition.
When headaches are a sign of a more serious illness, you may also have additional symptoms such as vomiting, dizziness, or changes in vision. A few uncommon but serious illnesses that can cause recurring, painful headaches along with other symptoms are a head injury, bleeding around the brain, or a brain infection or tumor.
What types of imaging tests evaluate headaches?
Most of the time, you do not need imaging tests to find a treatment for your headaches. Imaging tests may show changes in the brain and face that could lead to recurring headaches. The two imaging tests that may be used to evaluate headache pain are:
- CT scan of the head and face, which uses X-rays to take detailed pictures of structures inside the head and face.
- Magnetic resonance imaging (MRI) of the head, which takes pictures of structures inside the head and face and provides more detail than other tests, such as X-rays or a CT scan.
If you need more information, see the topics Headaches, Cluster Headaches, Migraine Headaches, or Tension Headaches.
Your Information
Keep in mind that imaging tests do not help your pain or change the type of treatment you may get for cluster, migraine, or tension headaches. And imaging tests do not always tell you what is causing your headaches. Your choices are:
- Have imaging tests to evaluate the cause of your headaches.
- Do not have imaging tests and continue taking prescribed medicines and watching the pattern of your headaches.
The decision about whether to have imaging tests to evaluate your headaches takes into account your personal feelings and the medical facts.
Imaging tests to evaluate your headaches Reasons to have imaging tests Reasons not to have imaging tests
- Medicines do not control your recurring, severe headaches.
- The pattern of your headaches has changed (gotten worse, more frequent, or you've developed symptoms such as numbness or tingling with the headaches).
- Your headaches did not begin until you were over the age of 50.
- You have not been diagnosed with cluster headaches but your headaches frequently wake you up at night.
- Your headaches started after you had a head injury.
- Your headache symptoms are not typical of any kind of headache (such as migraine, cluster, or tension headaches).
- You are so concerned or fearful about the cause of your headaches that the quality of your life is affected, and the cost of the tests will be less burdensome to you than the worry.
Are there other reasons you might want to have imaging tests to evaluate your headaches?
- Medicines effectively control or stop your headaches or prevent them from regularly occurring.
- Your headache pattern stays the same, with no new symptoms or changes in the frequency, severity, or location of pain.
- You did not have a head injury before the headaches began and, except for the headaches, you are otherwise healthy.
- The results of imaging tests will not guide your treatment for cluster headaches, migraine headaches, or tension headaches.
- Your headaches have occurred for months or years without getting worse. Headaches with more serious causes progress more quickly.
- You do not have insurance or your insurance does not cover an imaging test for your headaches. Imaging tests can be expensive.
Are there other reasons you might not want to have imaging tests to evaluate your headaches?
These personal stories may help you make your decision.
Wise Health Decision
Use this worksheet to help you make your decision. After completing the worksheet, you should have a better idea of how you feel about having imaging tests to evaluate your headaches. Discuss the worksheet with your doctor.
Circle the answer that best applies to you.
I started having headaches before the age of 50. Yes No NA* My doctor says my headache symptoms are classic migraine, cluster, or tension headaches. Yes No Unsure My headache pattern has remained pretty much the same. Yes No Unsure Prescription medicines usually stop or reduce my headache symptoms. Yes No Unsure Nonprescription pain relievers (like Tylenol or Advil) help my headache symptoms. Yes No Unsure I have had cluster headaches for years, but I am really worried that something terrible is causing these headaches. Yes No NA I have insurance or the ability to pay for imaging tests if I want to have them done. Yes No Unsure I've had recurring headaches for years, but recently, they feel different, are more severe, and occur more frequently. Yes No Unsure I have had a recent head injury or have been diagnosed with a serious medical condition (such as high blood pressure). Yes No Unsure *NA = Not applicable
Use the following space to list any other important concerns you have about this decision.
What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have imaging tests to evaluate your headaches.
Check the box below that represents your overall impression about your decision.
Leaning toward having imaging tests
Leaning toward NOT having imaging tests
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| Author: | Monica Rhodes | Last Updated: April 11, 2008 |
| Medical Review: | Anne C. Poinier, MD - Internal Medicine Colin Chalk, MD, CM, FRCPC - Neurology | |
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