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DOI: 10.1055/s-0034-1399140
Radiological Diagnosis and Differential Diagnosis of Headache
Radiologische Diagnostik und Differenzialdiagnostik bei Kopfschmerzen im ErwachsenenalterPublication History
09 July 2014
27 January 2015
Publication Date:
02 September 2015 (online)
![](https://www.thieme-connect.de/media/roefo/201510/lookinside/thumbnails/roefo-2340en_10-1055-s-0034-1399140-1.jpg)
Abstract
Headache is very common and affects almost everyone at some point. It is one of the most common disorders that leads patients to see their physician. All different forms have the nociception via trigeminal nerve fibers in common. Beside the clinical course headaches are classified as either primary or secondary, with the latter having an identifiable structural or biochemical cause. Imaging has a low diagnostic yield in primary headache but play an important role in the differential diagnosis of secondary forms. An overview of different forms of secondary headache is given, outlining diagnostic procedures and the morphologic imaging features of each syndrome.
Key points:
• Headache can be differentiated in primary and secondary forms.
• Imaging plays an important role in differential diagnosis of secondary forms.
• Imaging should be performed in patients with concomitant systemic or neurologic symptoms.
Citation Format:
• Langner S, Kirsch M, Hosten N Radiological Diagnosis and Differentialdiagnosis of Headache. Fortschr Röntgenstr 2015; 187: 879 – 891
Zusammenfassung
Kopfschmerzen sind eine der häufigsten Beschwerden, die zu einem Arztbesuch führen, und betreffen nahezu jeden einmal in seinem Leben. Gemeinsame pathophysiologische Endstrecke ist die Schmerzwahrnehmung über Trigeminusäste. Neben der Verlaufsform kann hinsichtlich der Ursache zwischen primären und sekundären Kopfschmerzen unterschieden werden, wobei die sekundären Kopfschmerzen Ausdruck einer zugrunde liegenden Erkrankung sind. Ist die diagnostische Ausbeute bei primären Kopfschmerzen gering, so spielt die Bildgebung bei den sekundären Formen eine entscheidende Rolle in der Differenzialdiagnostik. Verschiedene sekundäre Kopfschmerzformen werden vorgestellt und die zur Verfügung stehenden diagnostischen Verfahren sowie die bildmorphologischen Korrelate der einzelnen Krankheitsbilder beschrieben.
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References
- 1 Rasmussen BK, Jensen R, Schroll M et al. Epidemiology of headache in a general population – a prevalence study. Journal of clinical epidemiology 1991; 44: 1147-1157
- 2 Kohlmann T. Musculoskeletal pain in the population. Schmerz (Berlin, Germany) 2003; 17: 405-411
- 3 Jordan JE. Headache. American journal of neuroradiology 2007; 28: 1824-1826
- 4 (IHS) HCCotIHS. The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia: an international journal of headache 2013; 33: 629-808
- 5 Dodick DW. Clinical practice. Chronic daily headache. The New England journal of medicine 2006; 354: 158-165
- 6 Tsushima Y, Endo K. MR imaging in the evaluation of chronic or recurrent headache. Radiology 2005; 235: 575-579
- 7 Stuckey SL, Goh TD, Heffernan T et al. Hyperintensity in the subarachnoid space on FLAIR MRI. American journal of roentgenology 2007; 189: 913-921
- 8 Ozsarlak O, Van Goethem JW, Maes M et al. MR angiography of the intracranial vessels: technical aspects and clinical applications. Neuroradiology 2004; 46: 955-972
- 9 Kruit MC, van Buchem MA, Launer LJ et al. Migraine is associated with an increased risk of deep white matter lesions, subclinical posterior circulation infarcts and brain iron accumulation: the population-based MRI CAMERA study. Cephalalgia: an international journal of headache 2010; 30: 129-136
- 10 Swartz RH, Kern RZ. Migraine is associated with magnetic resonance imaging white matter abnormalities: a meta-analysis. Archives of neurology 2004; 61: 1366-1368
- 11 Palm-Meinders IH, Koppen H, Terwindt GM et al. Structural brain changes in migraine. JAMA: the journal of the American Medical Association 2012; 308: 1889-1897
- 12 Bashir A, Lipton RB, Ashina S et al. Migraine and structural changes in the brain: a systematic review and meta-analysis. Neurology 2013; 81: 1260-1268
- 13 May A. New insights into headache: an update on functional and structural imaging findings. Nature reviews Neurology 2009; 5: 199-209
- 14 Schwedt TJ. Thunderclap headaches: a focus on etiology and diagnostic evaluation. Headache 2013; 53: 563-569
- 15 van Gijn J, Kerr RS, Rinkel GJ. Subarachnoid haemorrhage. Lancet 2007; 369: 306-318
- 16 Marder CP, Narla V, Fink JR et al. Subarachnoid hemorrhage: beyond aneurysms. American journal of roentgenology 2014; 202: 25-37
- 17 McCormack RF. Third-generation CT has 100% sensitivity and specificity for identifying subarachnoid haemorrhage when it is carried out within 6h of headache onset. Evidence-based medicine 2012; 17: 27-28
- 18 Verma RK, Kottke R, Andereggen L et al. Detecting subarachnoid hemorrhage: comparison of combined FLAIR/SWI versus CT. European journal of radiology 2013; 82: 1539-1545
- 19 Deutsche Gesellschaft für Neurologie. Leitlinie Diagnostik und apparative Zusatzuntersuchungen bei Kopfschmerzen. http://www.awmf.org/leitlinien/detail/ll/030-110.html
- 20 Ducros A. Reversible cerebral vasoconstriction syndrome. Lancet neurology 2012; 11: 906-917
- 21 Yancy H, Lee-Iannotti JK, Schwedt TJ et al. Reversible cerebral vasoconstriction syndrome. Headache 2013; 53: 570-576
- 22 Marder CP, Donohue MM, Weinstein JR et al. Multimodal imaging of reversible cerebral vasoconstriction syndrome: a series of 6 cases. American journal of neuroradiology 2012; 33: 1403-1410
- 23 Chen SP, Fuh JL, Wang SJ et al. Magnetic resonance angiography in reversible cerebral vasoconstriction syndromes. Annals of neurology 2010; 67: 648-656
- 24 Abdel Razek AA, Alvarez H, Bagg S et al. Imaging spectrum of CNS vasculitis. Radiographics: a review publication of the Radiological Society of North America, Inc 2014; 34: 873-894
- 25 Bi WL, Dunn IF, Laws Jr ER. Pituitary apoplexy. Endocrine 2014; [epub ahead of print]
- 26 Rodallec MH, Marteau V, Gerber S et al. Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. Radiographics: a review publication of the Radiological Society of North America, Inc 2008; 28: 1711-1728
- 27 Hahnel S, Stippich C, Hartmann M et al. Injury of craniocervical arteries: imaging findings and therapy. Fortschr Röntgenstr 2007; 179: 119-129
- 28 Masuhr F, Mehraein S, Einhaupl K. Cerebral venous and sinus thrombosis. Journal of neurology 2004; 251: 11-23
- 29 Edlow JA, Caplan LR, O'Brien K et al. Diagnosis of acute neurological emergencies in pregnant and post-partum women. Lancet neurology 2013; 12: 175-185
- 30 Weimar C. Diagnosis and treatment of cerebral venous and sinus thrombosis. Current neurology and neuroscience reports 2014; 14: 417
- 31 Linn J, Pfefferkorn T, Ivanicova K et al. Noncontrast CT in deep cerebral venous thrombosis and sinus thrombosis: comparison of its diagnostic value for both entities. American journal of neuroradiology 2009; 30: 728-735
- 32 Linn J, Bruckmann H. Cerebral Venous and Dural Sinus Thrombosis*: State-of-the-Art Imaging. Clinical neuroradiology 2010; 20: 25-37
- 33 Osborn AG, Preece MT. Intracranial cysts: radiologic-pathologic correlation and imaging approach. Radiology 2006; 239: 650-664
- 34 El Khoury C, Brugieres P, Decq P et al. Colloid cysts of the third ventricle: are MR imaging patterns predictive of difficulty with percutaneous treatment?. American journal of neuroradiology 2000; 21: 489-492
- 35 Molina-Martinez FJ, Jimenez-Martinez MC, Vives-Pastor B. Some questions provoked by a chronic headache (with mixed migraine and cluster headache features) in a woman with a pineal cyst. Answers from a literature review. Cephalalgia: an international journal of headache 2010; 30: 1031-1040
- 36 Hahnel S, Storch-Hagenlocher B, Kress B et al. Infectious diseases of brain parenchyma in adults: imaging and differential diagnosis aspects. Fortschr Röntgenstr 2005; 177: 1349-1365
- 37 Krope K, Speil A, Pantazis G et al. MR imaging in the diagnosis of primary and secondary cerebral infections. Fortschr Röntgenstr 2013; 185: 539-545
- 38 Edlow JA, Panagos PD, Godwin SA et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Annals of emergency medicine 2008; 52: 407-436
- 39 Joshi SG, Cho TA. Pathophysiological mechanisms of headache in patients with HIV. Headache 2014; 54: 946-950
- 40 van Crevel H, Hijdra A, de Gans J. Lumbar puncture and the risk of herniation: when should we first perform CT?. Journal of neurology 2002; 249: 129-137
- 41 Degnan AJ, Levy LM. Pseudotumor cerebri: brief review of clinical syndrome and imaging findings. American journal of neuroradiology 2011; 32: 1986-1993
- 42 Rohr A, Riedel C, Reimann G et al. Pseudotumor cerebri: quantitative in-vivo measurements of markers of intracranial hypertension. Fortschr Röntgenstr 2008; 180: 884-890
- 43 Schievink WI, Maya MM, Louy C et al. Diagnostic criteria for spontaneous spinal CSF leaks and intracranial hypotension. American journal of neuroradiology 2008; 29: 853-856
- 44 Kranz PG, Gray L, Taylor JN. CT-guided epidural blood patching of directly observed or potential leak sites for the targeted treatment of spontaneous intracranial hypotension. American journal of neuroradiology 2011; 32: 832-838
- 45 Cornelius RS, Martin J, Wippold FJ et al. ACR appropriateness criteria sinonasal disease. Journal of the American College of Radiology: JACR 2013; 10: 241-246
- 46 Hoang JK, Eastwood JD, Tebbit CL et al. Multiplanar sinus CT: a systematic approach to imaging before functional endoscopic sinus surgery. American journal of roentgenology 2010; 194: W527-W536
- 47 Damann F, Bootz F, Cohnen M et al. Diagnostic Imaging modalities in head and neck disease. Deutsches Arzteblatt international 2014; 111: 417-423
- 48 Langner S, Schroeder HW, Hosten N et al. Diagnosing neurovascular compression syndromes. Fortschr Röntgenstr 2012; 184: 220-228
- 49 Colnaghi S, Versino M, Marchioni E et al. ICHD-II diagnostic criteria for Tolosa-Hunt syndrome in idiopathic inflammatory syndromes of the orbit and/or the cavernous sinus. Cephalalgia: an international journal of headache 2008; 28: 577-584
- 50 Russo A, D'Onofrio F, Conte F et al. Post-traumatic headaches: a clinical overview. Neurological sciences: official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 2014; 35 (Suppl. 01) 153-156