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Imaging of Headache

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Pain Imaging

Abstract

Headache is a very common clinical feature in daily practice. Most patients are affected by the so-called primary headache and do not require neuroimaging as the diagnosis is based on the history and clinical data. In patients noncompliant to therapy, with abnormal neurological examination or worsening of symptoms, imaging is useful. Imaging is especially mandatory to rule out underlying causes of headache.

In this chapter we will review the imaging pattern of the most frequent primary headaches and of the most frequent causes of secondary headache in which neuroimaging plays a fundamental role.

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Authors and Affiliations

  1. SC (UCO) Radiologia Diagnostica e Interventistica, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy

    Maja Ukmar

  2. University of Trieste, Department of Radiology, Cattinara Hospital, Trieste, Italy

    Roberta Pozzi Mucelli, Irene Zorzenon & Maria Assunta Cova

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  1. Maja Ukmar
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  2. Roberta Pozzi Mucelli
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  4. Maria Assunta Cova
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Correspondence to Maja Ukmar .

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Editors and Affiliations

  1. Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy

    Maria Assunta Cova

  2. Department of Radiology, Maggiore Hospital, Trieste, Italy

    Fulvio Stacul

4.1 Electronic Supplementary Material

Patient with migraine and aura. Axial SE T2-weighted sequence shows supratentorial white matter hyperintensities. (AVI 1477 kb)

Amyloid angiopathy. Axial SE T2-weighted (a) sequences show a diffuse enlargement of perimesencephalic subarachnoid spaces associated with focal and partially confluent hyperintense white matter subcortical and periventricular areas. (AVI 1477 kb)

Amyloid angiopathy. FLAIR (b) sequences show a diffuse enlargement of perimesencephalic subarachnoid spaces associated with focal and partially confluent hyperintense white matter subcortical and periventricular areas. (AVI 1477 kb)

Amyloid angiopathy. GRE T2* sequence (c) allows the identification of cortical, subcortical, and subarachnoid hemosiderin deposition. (AVI 1477 kb)

Cavernous malformation in patient with headache. Axial SE T2w (a) sequences show a large cavernoma in left frontal lobe with subacute bleeding, and a smaller cavernoma in right parietal lobe. (AVI 1477 kb)

Cavernous malformation in patient with headache. SE T1w (b) sequences show a large cavernoma in left frontal lobe with subacute bleeding, and a smaller cavernoma in right parietal lobe. (AVI 1477 kb)

Vertebral artery dissection in patient with acute cervical pain and headache. Axial SE T1w image (a) shows a focal hyperintensity in the lumen of the left vertebral artery. MRA source image. (AVI 1541 kb)

Vertebral artery dissection in patient with acute cervical pain and headache. Axial SE T1w image (b) shows the intimal flap within the vessel and MIP reconstruction (c) confirms the absence of flow signal in the left vertebral artery. (AVI 25606 kb)

Vertebral artery dissection in patient with acute cervical pain and headache. Axial SE T1w image (c) confirms the absence of flow signal in the left vertebral artery. (AVI 7685 kb)

Cerebral venous thrombosis in patient with headache. Unenhanced CT scan (a) shows hyperdensity in superior sagittal sinus (SSS) with empty delta sign on enhanced CT. (AVI 18438 kb)

Cerebral venous thrombosis in patient with headache. Unenhanced CT scan (b) shows hyperdensity in superior sagittal sinus (SSS) with empty delta sign on enhanced CT. (AVI 1477 kb)

Cerebral venous thrombosis in patient with headache. MRI shows hyperintense signal at the level of frontoparietal sulci on FLAIR image (c). (AVI 1477 kb)

Cerebral venous thrombosis in patient with headache. It confirmed the presence of a subacute thrombus in SSS and cortical veins on T1 w image (d). (AVI 1477 kb)

Cerebral venous thrombosis in patient with headache. Lack of opacification after contrast media (e). (AVI 40968 kb)

Cerebral venous thrombosis in patient with headache. Lack of opacification after contrast media (f). (AVI 1541 kb)

Cerebral venous thrombosis in patient with headache. Follow-up scan demonstrated resolution of the thrombosis with disappearance of hyperintensity on FLAIR image (g). (AVI 1541 kb)

Cerebral venous thrombosis in patient with headache. Follow-up scan demonstrated resolution of the thrombosis with disappearance of thrombus on T1w image (h). (AVI 1541 kb)

Cerebral venous thrombosis in patient with headache. Follow-up scan demonstrated resolution of the thrombosis with disappearance of complete opacification of SSS (i). (AVI 11023 kb)

Recurrent headache and stroke episodes in patients with CADASIL. Large, confluent, symmetrical subcortical white matter hyperintensities on SE T2w (a). (AVI 1477 kb)

Recurrent headache and stroke episodes in patients with CADASIL. FLAIR (b) sequences, with involvement of the external capsula and the anterior temporal poles. (AVI 1477 kb)

Long-standing intractable headache in patient with spontaneous intracranial hypotension. T2w image (a) shows slight enlargement of subdural frontal space. (AVI 1477 kb)

Long-standing intractable headache in patient with spontaneous intracranial hypotension. A subtle hyperintense subdural collection is seen on FLAIR image (b). (AVI 1477 kb)

Long-standing intractable headache in patient with spontaneous intracranial hypotension. Diffuse thickening and pachymeningeal enhancement is seen on T1w image after contrast media (c). (AVI 1477 kb)

Long-standing intractable headache in patient with spontaneous intracranial hypotension. Myelo-RM (d, e) well demonstrates spontaneous CSF leakage at the level of C2–C3. (AVI 2052 kb)

Intracranial hypertension and headache. Sagittal (a). STIR images show flattened posterior sclera (a). (AVI 1017 kb)

Intracranial hypertension and headache. Coronal (b). Prominent subarachnoid space around the optic nerve (b). (AVI 1541 kb)

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Ukmar, M., Pozzi Mucelli, R., Zorzenon, I., Cova, M.A. (2019). Imaging of Headache. In: Cova, M., Stacul, F. (eds) Pain Imaging. Springer, Cham. https://doi.org/10.1007/978-3-319-99822-0_4

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