Ambulatory evaluation of the adult with new nontraumatic headache

MRI: magnetic resonance imaging; CT: computed tomography; MR: magnetic resonance; LP: lumbar puncture; CSF: cerebrospinal fluid.

* Head CT may be preferred imaging test for acute or severe headaches when quicker to perform or more readily available than MRI and for patients unable to have an MRI. Brain MRI may be preferred for patients with chronic symptoms and when initial head CT is nondiagnostic.

¶ Refer to UpToDate topics on the evaluation of headache for additional details on secondary causes of headache.

Δ CT- or MR-venography of the head may also be warranted for patients with suspected cerebral venous thrombosis.

◊ Additional imaging including myelography may be warranted for some patients with a suspected spinal source to headache (eg, spontaneous intracranial hypotension) when initial imaging is nondiagnostic.

§ Primary headache syndromes include migraine and related conditions, tension-type headaches, trigeminal autonomic cephalalgias (cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks, and hemicrania continua), and less common primary headache disorders (eg, new persistent daily headache, primary cough headache, primary exercise headache). Refer to UpToDate topics for additional details.