J Korean Soc Radiol.  2019 Sep;80(5):880-895. 10.3348/jksr.2019.80.5.880.

Korean Clinical Imaging Guidelines for Diagnosis of Headache Based on the 2017 Evidence-Based Clinical Imaging Guidelines

• Jung JS
• Oh SW
• Jang J
• Choi CH
• Kim SC
• Moon WJ
• Choi M
• Jung SE

• KMID: 2459014
• DOI: http://doi.org/10.3348/jksr.2019.80.5.880

Abstract

Headache is the most common cause of neurological disorders. The usefulness of imaging tests may vary depending on the patient's clinical situation. The Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency have decided to develop evidence-based guidelines for the imaging tests necessary for diagnosing patients with selected, frequently encountered types of headache. Development, working, and advisory committees were formed. Recommendation statements were derived from the adaptive development methods provided by the existing guidelines. Non-contrast head CT is recommended in patients with acute thunderclap headache due to possible subarachnoid hemorrhage (SAH), and CT angiography is recommended to confirm aneurysmal SAH. In patients with non-acute headache and normal neurological findings, radiological examination is not recommended, but head MRI is recommended to investigate the cause of secondary headache. Non-contrast head MRI is recommended for new-onset headache with neurologic abnormalities in pregnant women.

MeSH Terms

Advisory Committees
Aneurysm
Angiography
Diagnosis*
Evidence-Based Practice
Female
Head
Headache Disorders, Primary
Headache*
Humans
Magnetic Resonance Imaging
Nervous System Diseases
Pregnant Women
Subarachnoid Hemorrhage

Figure

• 

  Fig. 1 Flow diagram of guideline selection (Key Questions 1, 2, and 3). C = comparator, GIN = Guideline International Network, I = intervention, KoMGI = Korean Medical Guideline Information Center, NGC = National Guideline Clearinghouse, O = outcome, P = population

Reference

1. Carville S, Padhi S, Reason T, Underwood M. Guideline Development Group. Diagnosis and management of headaches in young people and adults: summary of NICE guidance. BMJ. 2012; 345:e5765.

2. Kim BK, Chu MK, Lee TG, Kim JM, Chung CS, Lee KS. Prevalence and impact of migraine and tension-type headache in Korea. J Clin Neurol. 2012; 8:204–211.

3. Duncan CW, Watson DP, Stein A. Guideline Development Group. Diagnosis and management of headache in adults: summary of SIGN guideline. BMJ. 2008; 337:a2329.

4. Cho WS, Kim JE, Park SQ, Ko JK, Kim DW, Park JC, et al. Korean clinical practice guidelines for aneurysmal subarachnoid hemorrhage. J Korean Neurosurg Soc. 2018; 61:127–166.

5. Edlow JA, Caplan LR, O'Brien K, Tibbles CD. Diagnosis of acute neurological emergencies in pregnant and post-partum women. Lancet Neurol. 2013; 12:175–185.

6. Ramchandren S, Cross BJ, Liebeskind DS. Emergent headaches during pregnancy: correlation between neurologic examination and neuroimaging. AJNR Am J Neuroradiol. 2007; 28:1085–1087.

7. Expert Panel on MR Safety. Kanal E, Barkovich AJ, Bell C, Borgstede JP, Bradley WG Jr, et al. ACR guidance document on MR safe practices: 2013. J Magn Reson Imaging. 2013; 37:501–530.

8. American College of Radiology. ACR-SPR Practice parameter for imaging pregnant or potentially pregnant adolescents and women with ionizing radiation. Published 2018. Accessed Oct 17, 2018. Available at. https://www.acr.org/-/media/ACR/Files/Practice-Parameters/Pregnant-Pts.pdf.

9. Mortimer AM, Bradley MD, Likeman M, Stoodley NG, Renowden SA. Cranial neuroimaging in pregnancy and the post-partum period. Clin Radiol. 2013; 68:500–508.

10. Korean Academy of Medical Sciences. Development of evidence-based clinical imaging guidelines II. Published 2016. Accessed Oct 17, 2018. Available at. http://www.guideline.or.kr/guide/view.php?number=55&cate=B.

11. Korean Academy of Medical Sciences. Korean appraisal of guideline for research & evaluation II. Published 2016. Accessed Oct 17, 2018. Available at. http://guideline.or.kr/evaluation/sub3.php.

12. Harling DW, Peatfield RC, Van Hille PT, Abbott RJ. Thunderclap headache: is it migraine? Cephalalgia. 1989; 9:87–90.

13. Linn FH, Wijdicks EF, Van der Graaf Y, Weerdesteyn-van Vliet FA, Bartelds AI, Van Gijn J. Prospective study of sentinel headache in aneurysmal subarachnoid haemorrhage. Lancet. 1994; 344:590–593.

14. Lledo A, Calandre L, Martinez-Menendez B, Perez-Sempere A, Portera-Sanchez A. Acute headache of recent onset and subarachnoid hemorrhage: a prospective study. Headache. 1994; 34:172–174.

15. Van der Wee N, Rinkel GJ, Hasan D, Van Gijn J. Detection of subarachnoid haemorrhage on early CT: is lumbar puncture still needed after a negative scan? J Neurol Neurosurg Psychiatry. 1995; 58:357–359.

16. Al-Shahi R, White PM, Davenport RJ, Lindsay KW. Subarachnoid haemorrhage. BMJ. 2006; 333:235–240.

17. Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med. 2006; 354:387–396.

18. Jayaraman MV, Mayo-Smith WW, Tung GA, Haas RA, Rogg JM, Mehta NR, et al. Detection of intracranial aneurysms: multi-detector row CT angiography compared with DSA. Radiology. 2004; 230:510–518.

19. McCormack RF, Hutson A. Can computed tomography angiography of the brain replace lumbar puncture in the evaluation of acute-onset headache after a negative noncontrast cranial computed tomography scan? Acad Emerg Med. 2010; 17:444–451.

20. Rana AK, Turner HE, Deans KA. Likelihood of aneurysmal subarachnoid haemorrhage in patients with normal unenhanced CT, CSF xanthochromia on spectrophotometry and negative CT angiography. J R Coll Physicians Edinb. 2013; 43:200–206.

21. Douglas AC, Wippold FJ 2nd, Broderick DF, Aiken AH, Amin-Hanjani S, Brown DC, et al. ACR appropriateness criteria headache. J Am Coll Radiol. 2014; 11:657–667.

22. Silbert PL, Mokri B, Schievink WI. Headache and neck pain in spontaneous internal carotid and vertebral artery dissections. Neurology. 1995; 45:1517–1522.

23. Jeong HW, Seo JH, Kim ST, Jung CK, Suh SI. Clinical practice guideline for the management of intracranial aneurysms. Neurointervention. 2014; 9:63–71.

24. Becker WJ, Findlay T, Moga C, Scott NA, Harstall C, Taenzer P. Guideline for primary care management of headache in adults. Can Fam Physician. 2015; 61:670–679.

25. National Clinical Guideline Centre (UK). Headaches: Diagnosis and Management of Headaches in Young People and Adults. London: Royal College of Physicians (UK);2012.

26. Sempere AP, Porta-Etessam J, Medrano V, Garcia-Morales I, Concepción L, Ramos A, et al. Neuroimaging in the evaluation of patients with non-acute headache. Cephalalgia. 2005; 25:30–35.

27. Becker LA, Green LA, Beaufait D, Kirk J, Froom J, Freeman WL. Use of CT scans for the investigation of headache: a report from ASPN, Part 1. J Fam Pract. 1993; 37:129–134.

28. Demaerel P, Boelaert I, Wilms G, Baert AL. The role of cranial computed tomography in the diagnostic workup of headache. Headache. 1996; 36:347–348.

29. Jordan JE, Ramirez GF, Bradley WG, Chen DY, Lightfoote JB, Song A. Economic and outcomes assessment of magnetic resonance imaging in the evaluation of headache. J Natl Med Assoc. 2000; 92:573–578.

30. Mitchell CS, Osborn RE, Grosskreutz SR. Computed tomography in the headache patient: is routine evaluation really necessary? Headache. 1993; 33:82–86.

31. Reinus WR, Erickson KK, Wippold FJ 2nd. Unenhanced emergency cranial CT: optimizing patient selection with univariate and multivariate analyses. Radiology. 1993; 186:763–768.

32. Weingarten S, Kleinman M, Elperin L, Larson EB. The effectiveness of cerebral imaging in the diagnosis of chronic headache. Arch Intern Med. 1992; 152:2457–2462.

33. Cull RE. Investigation of late-onset migraine. Scott Med J. 1995; 40:50–52.

34. Frishberg BM. The utility of neuroimaging in the evaluation of headache in patients with normal neurologic examinations. Neurology. 1994; 44:1191–1197.

35. Nawaz M, Amin A, Qureshi AN, Jehanzeb M. Audit of appropriateness and outcome of computed tomography brain scanning for headaches in paediatric age group. J Ayub Med Coll Abbottabad. 2009; 21:91–93.

36. Tsushima Y, Endo K. MR imaging in the evaluation of chronic or recurrent headache. Radiology. 2005; 235:575–579.

37. Wang HZ, Simonson TM, Greco WR, Yuh WT. Brain MR imaging in the evaluation of chronic headache in patients without other neurologic symptoms. Acad Radiol. 2001; 8:405–408.

38. Vernooij MW, Ikram MA, Tanghe HL, Vincent AJ, Hofman A, Krestin GP, et al. Incidental findings on brain MRI in the general population. N Engl J Med. 2007; 357:1821–1828.

39. Forsyth PA, Posner JB. Headaches in patients with brain tumors: a study of 111 patients. Neurology. 1993; 43:1678–1683.

40. Evers S, Afra J, Frese A, Goadsby PJ, Linde M, May A, et al. EFNS guideline on the drug treatment of migraine--revised report of an EFNS task force. Eur J Neurol. 2009; 16:968–981.

41. Hoang JK, Branstetter BF 4th, Gafton AR, Lee WK, Glastonbury CM. Imaging of thyroid carcinoma with CT and MRI: approaches to common scenarios. Cancer Imaging. 2013; 13:128–139.

42. Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW. American College of Emergency Physicians. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med. 2008; 52:407–436.

43. Meurer WJ, Walsh B, Vilke GM, Coyne CJ. Clinical guidelines for the emergency department evaluation of subarachnoid hemorrhage. J Emerg Med. 2016; 50:696–701.

44. Mitsikostas DD, Ashina M, Craven A, Diener HC, Goadsby PJ, Ferrari MD, et al. European Headache Federation consensus on technical investigation for primary headache disorders. J Headache Pain. 2015; 17:5.