What does a diagnosis of mild cerebral atrophy without any acute intracranial abnormalities, no mass effect, midline shift, hemorrhage, or acute infarct mean for an older adult's headaches?

Understanding Your Brain Scan Results and Their Relationship to Headaches

Your brain scan shows mild age-related brain shrinkage (cerebral atrophy) with no dangerous or urgent problems—this finding alone does not explain your headaches and is commonly seen in normal aging.

What the Scan Results Mean in Plain Language

Your CT scan shows two main things:

• Mild cerebral atrophy: This means your brain has slightly less volume than it did when you were younger—think of it as normal "wear and tear" that happens as we age. 1

• No acute intracranial abnormality: This is the most important part—there is nothing dangerous or urgent happening in your brain right now. Specifically:

  • No mass effect or midline shift: Your brain structures are in their normal positions, not being pushed aside by anything 2
  • No hemorrhage: No bleeding in or around your brain 3
  • No acute infarct: No recent stroke 2

Does This Explain Your Headaches?

No, mild cerebral atrophy does not typically cause headaches. 1

Here's why this matters:

• Studies of patients with "primary" brain atrophy (atrophy without other brain diseases) show that headache is a common reason people get scanned, but the atrophy itself is not the cause of the headache 1

• The yield of finding significant pathology on brain scans in patients with headaches and normal neurological exams is extremely low—only 0.2%, which is the same rate as finding abnormalities in people without any symptoms 4, 5

• Your scan specifically ruled out the dangerous causes of headaches that we worry about: bleeding, stroke, tumors, and increased pressure in the skull 3, 4

What This Means for Your Headache Evaluation

Since the scan is essentially normal (mild atrophy is not a disease), your headaches are most likely due to a primary headache disorder such as:

• Migraine headaches 4, 6
• Tension-type headaches 6
• Other benign headache syndromes 7

The good news: The scan has successfully ruled out serious structural problems that would require urgent treatment. 4

Important Caveats

Your doctor ordered this scan for a reason. You should still discuss with them if you have any of these concerning features that might warrant further evaluation:

• Headaches that wake you from sleep 4, 8
• Progressively worsening headaches over weeks 6, 8
• "Worst headache of your life" or thunderclap onset 4, 5
• Headaches that worsen with coughing, straining, or bending over 4, 7
• New headaches if you're over age 50 4, 5
• Any abnormal findings on your neurological examination 4, 8

Bottom Line

Your scan is reassuring. The mild brain atrophy is an incidental finding that represents normal aging and does not cause your headaches. 1 The absence of acute abnormalities means there is no structural emergency requiring immediate intervention. 3 Your headaches likely represent a primary headache disorder that should be managed with appropriate headache treatments rather than further brain imaging. 4, 6