Who needs an image for chronic headache to rule-out CNS disease?
- Abnormal neuro exam;
- Progressive headache;
- Red Flags:
- Associated with daily nausea / vomiting;
- Softer clue: worsening with valsalvas or bending forward. Contrary to popular opinion, early morning onset is not a feature;
- Elderly patients, & those taking anticoagulants, who can have occult subdural hematomas [“elderly” sometimes defined as “over 50”];
- 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.