Is Imaging Necessary for Patients With Headache?

There are many controversies around neuroimaging; one of them being whether it is appropriate for patients with headache. This was the basis of a lively debate at the American Academy of Neurology’s 2019 Annual Meeting.

James Johnston MD, JD, from Global Neuro Care, was PRO imaging for headache, and James Burke, MD, MS, from Michigan Medicine, was CON imaging.

For his PRO argument, Dr Johnston started by saying computed tomography (CT) scan should not be used for patients with headache, but other scans should be used earlier in the diagnosis window, because “earlier imaging allows for earlier treatment, more options, and improved outcomes.”

In addition, he said that imaging significantly reduces costs related to comorbid anxiety and depression, which are often associated with chronic headache. Incidental findings, such as aneurysms or signs of stroke, warrant further investigation and monitoring.

He concluded his argument by urging the audience to “choose your imaging study wisely, and first ask yourself ‘Do I need an imaging study for this headache?”—because the costs of misdiagnosis and mismanagement are high.

After that, Dr Burke took the stage with his CON argument, stating that there is too much headache imaging occurring.

He based his argument on the facts that headache is one of the most common presenting symptoms in neurology, and brain tumors are rare—one of the most common concerns for patients presenting with headache.

He also went into detail about how current guidelines on headache imaging do not recommend imaging for every headache and that trends show that more imaging for headache does not increase the understanding of etiology.

Dr Burke closed his argument by saying that the harms of magnetic resonance imaging are not zero, which means ordering too many or inappropriate scans may actually harm your patient.

After a few closing remarks from both Drs Johnston and Burke, the audience was polled about their view.

What do you think? Which side of the argument are you on? Take our poll below to let us know!



—Amanda Balbi


Johnston J, Burke J. Controversies in neuroimaging. Presented at: American Academy of Neurology’s 2019 Annual Meeting; May 4-10, 2019; Philadelphia, PA. http://tools.aan.com/annualmeeting/search/?fuseaction=home.detail&id=7318&_ga=2.166395709.22758629.1557146083-1571547560.1551707097. Accessed May 7, 2019.