Should I have image tests to evaluate my headaches?

Should I have image tests to evaluate my headaches?
Introduction
Medical Information
Your Information
Wise Health Decision
Credits

Content provided by Healthwise

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, migraines, or tension headaches, are not caused by another serious condition (such as a brain tumor), and their cause will not show up on image tests.
It is unusual to develop new, painful headaches after age 50. Image tests may help diagnose the cause of these types of headaches.
Medications often effectively control the pain of recurring headaches—such as tension, migraine, or cluster headaches—and image test results will not affect your treatment.
If you have recurring headaches but medications 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—image 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, image 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 image tests evaluate headaches?

Most of the time, you do not need image tests to find a treatment for your headaches. Image tests may show changes in the brain and face that could lead to recurring headaches. The two image 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 image tests do not help your pain or change the type of treatment for cluster, migraine, or tension headaches. Your choices are:

Have image tests to evaluate the cause of your headaches.
Do not have image tests and continue taking prescribed medications and monitoring the pattern of your headaches.

The decision about whether to have image tests to evaluate your headaches takes into account your personal feelings and the medical facts.

**Image tests to evaluate your headaches**
Reasons to have image tests	Reasons not to have image tests
Medications 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. 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 image tests to evaluate your headaches?	Medications effectively control or stop your headaches or prevent them from regularly occurring. Your headache pattern remains 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 image tests will not guide your treatment for cluster headaches, migraine headaches, or tension headaches. Your headaches have occurred for months or years without worsening. Headaches with more serious causes progress more quickly. Are there other reasons you might not want to have image 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 image 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 headaches, or tension headaches.	Yes	No	Unsure
My headache pattern has remained relatively the same.	Yes	No	Unsure
Prescription medications usually stop or reduce my headache symptoms.	Yes	No	Unsure
Nonprescription pain relievers (like Tylenol or Advil) do not reduce 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 image 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 not had a recent head injury or 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 image tests

Leaning toward NOT having image tests

Return to the topics:

Credits

Author	Ralph Poore
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Michele Cronen
Associate Editor	Pat Truman
Primary Medical Reviewer	Renée M. Crichlow, MD - Family Medicine
Specialist Medical Reviewer	Seymour Diamond, MD - Neurology
Last Updated	April 21, 2006

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Last updated:	April 21, 2006
Author:	Ralph Poore
Reviewed By:	Renée M. Crichlow, MD - Family Medicine, Seymour Diamond, MD - Neurology
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman

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