Mass Lesions (as cause of Chronic H/A)

Who needs an image for chronic headache to rule-out CNS disease?

  • Abnormal neuro exam;
  • Progressive headache;
  • Red Flags:
    1. Associated with daily nausea / vomiting;
    2. Softer clue: worsening with valsalvas or bending forward.  Contrary to popular opinion, early morning onset is not a feature;
    3. Elderly patients, & those taking anticoagulants, who can have occult subdural hematomas [“elderly” sometimes defined as “over 50”];
    4. Persons over 50 with a completely new headache are more likely to have tumors.

A non-contrast CT should suffice.  MRI is more sensitive for masses overall, but not necessarily for those large enough to cause headache.

See posting Chronic Headache.