title: ACR Appropriateness Criteria Headache.
abstract: Most patients presenting with uncomplicated, nontraumatic, primary headache do not require imaging. When history, physical, or neurologic examination elicits "red flags" or critical features of the headache, then further investigation with imaging may be warranted to exclude a secondary cause. Imaging procedures may be diagnostically useful for patients with headaches that are: associated with trauma; new, worse, or abrupt onset; thunderclap; radiating to the neck; due to trigeminal autonomic cephalgia; persistent and positional; and temporal in older individuals. Pregnant patients, immunocompromised individuals, cancer patients, and patients with papilledema or systemic illnesses, including hypercoagulable disorders may benefit from imaging. Unlike most headaches, those associated with cough, exertion, or sexual activity usually require neuroimaging with MRI of the brain with and without contrast to exclude potentially underlying pathology before a primary headache syndrome is diagnosed. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: Indiana University Hospital, Indianapolis, Indiana.
authors.forename: Annette C
authors.initials: AC
authors.lastname: Douglas
authors.affiliation: Mallinckrodt Institute of Radiology, Saint Louis, Missouri. Electronic address: wippoldf@mir.wustl.edu.
authors.forename: Franz J
authors.initials: FJ
authors.lastname: Wippold
authors.affiliation: Mayo Clinic Jacksonville, Jacksonville, Florida.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Broderick
authors.affiliation: Emory Healthcare, Atlanta, Georgia.
authors.forename: Ashley H
authors.initials: AH
authors.lastname: Aiken
authors.affiliation: University of Illinois College of Medicine, Chicago, Illinois; American Association of Neurological Surgeons, Rolling Meadows, Illinois/Congress of Neurological Surgeons, Schaumburg, Illinois.
authors.forename: Sepideh
authors.initials: S
authors.lastname: Amin-Hanjani
authors.affiliation: Hampton Roads Radiology Associates, Norfolk, Virginia.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Brown
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Corey
authors.affiliation: Mount Sinai School of Medicine, New York, New York; American Association of Neurological Surgeons, Rolling Meadows, Illinois/Congress of Neurological Surgeons, Schaumburg, Illinois.
authors.forename: Isabelle M
authors.initials: IM
authors.lastname: Germano
authors.affiliation: Physicians Regional Medical Center, Naples, Florida; American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia.
authors.forename: James A
authors.initials: JA
authors.lastname: Hadley
authors.affiliation: University of Minnesota, Minneapolis, Minnesota.
authors.forename: Bharathi D
authors.initials: BD
authors.lastname: Jagadeesan
authors.affiliation: Walter Reed National Military Medical Center, Bethesda, Maryland, Society of Nuclear Medicine and Molecular Imaging, Reston, Virginia.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Jurgens
authors.affiliation: University of Wisconsin Hospital and Clinic, Madison, Wisconsin.
authors.forename: Tabassum A
authors.initials: TA
authors.lastname: Kennedy
authors.affiliation: Dent Neurologic Institute, Amherst, New York; American Academy of Neurology, Minneapolis, Minnesota.
authors.forename: Laszlo L
authors.initials: LL
authors.lastname: Mechtler
authors.affiliation: Fairfax Radiology Consultants PC, Fairfax, Virginia.
authors.forename: Nandini D
authors.initials: ND
authors.lastname: Patel
authors.affiliation: Washington University School of Medicine, St. Louis, Missouri, American Association of Neurological Surgeons, Rolling Meadows, Illinois/Congress of Neurological Surgeons, Schaumburg, Illinois.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Zipfel
mesh_terms: D003952:Diagnostic Imaging / Q000592:standards*; D006261:Headache / Q000145:classification* / Q000175:diagnosis*; D006801:Humans; D017410:Practice Guidelines as Topic; D011871:Radiology / Q000592:standards*; D014481:United States
keywords: Appropriateness criteria; headache; hemorrhage; mass; thunderclap