From the Guidelines
If you're experiencing headaches without a history of trauma and haven't had imaging studies like MRI or CT scans, you should first try over-the-counter pain relievers and lifestyle modifications for symptom relief, as imaging is not usually warranted for patients with normal neurological examination, according to the most recent guidelines 1. When managing headaches without trauma, it's essential to consider the underlying causes and potential risks. The American College of Radiology recommends that imaging may be appropriate for evaluation of cervicogenic headache without neurologic deficit, but it is not always indicated 1. Some key points to consider when evaluating headaches without trauma include:
- Keeping a headache diary to track triggers like stress, certain foods, sleep patterns, or environmental factors
- Staying hydrated by drinking 8-10 glasses of water daily and maintaining regular sleep patterns
- Applying a cold or warm compress to your head or neck for 10-15 minutes for tension headaches
- Consulting a healthcare provider promptly if headaches are severe, persistent, accompanied by other symptoms like fever or vision changes, or significantly impact your daily life The data from studies on chronic headache patients suggest that imaging will almost always be unnecessary if the history is one of tension type headache and the neurological examination is normal 1. However, it's crucial to note that proper medical evaluation is important for persistent or severe cases to rule out more serious conditions, and healthcare providers may recommend imaging studies if your headaches suggest underlying conditions requiring investigation 1.
From the Research
Diagnosis of Headaches without Trauma
- A thorough history and physical examination can help physicians differentiate primary headaches from secondary headaches 2
- The International Headache Society classification and diagnostic criteria can be used to identify primary headaches such as tension, migraine, and cluster headaches 2
- Red flag signs and symptoms, such as focal neurologic signs, papilledema, and neck stiffness, can indicate serious underlying pathology and may require neuroimaging or other testing 2
Neuroimaging for Headaches
- Neuroimaging, such as MRI or CT scan, is not always necessary for the diagnosis of headaches 2, 3
- Imaging is generally not warranted for primary headaches, but may be necessary for secondary headaches or when red flag signs and symptoms are present 2, 3
- If an intracranial hemorrhage is suspected, head computed tomography without contrast media is recommended 2
Treatment of Headaches
- Acute migraine treatment includes acetaminophen, nonsteroidal anti-inflammatory drugs, and combination products that include caffeine 4, 5, 6
- Migraine-specific treatments, such as triptans, can be effective for moderate to severe migraines, but may have adverse effects and are not recommended for patients with cardiovascular disease 4, 5, 6
- Preventive treatments, such as antihypertensives, antiepileptics, and calcitonin gene-related peptide monoclonal antibodies, can reduce migraine frequency 5