Why might I need a head MRI scan?

Most patients who suffer from headaches do not need an MRI. For example, if a young patient presents with features that are very typical for migraine, and has a family history of migraine, often further work up, including an MRI, is not needed. 

Generally, physicians will order a brain MRI when there is something atypical about the presentation, or the patient reports a "red flag." Red flags are pieces of information gained from the history or physical exam that are unusual for primary headache syndromes (such as migraine and tension type headaches). Examples include fever, neurologic deficits such as numbness or weakness, sudden onset severe headache with no prior history, weight loss, change in vision, or a pronounced positional component to the headache. Additionally, if a person over fifty is presenting with new onset headaches, an image is often done as it is rare for an older person to be presenting for the first time with a primary headache syndrome. 

Finally, if a patient has a known diagnosis of a primary headache disorder, such as migraine, but there is a sudden change in the pattern of the headache, for example the frequency increases dramatically or the headaches become much more severe, then their neurologist may consider ordering an MRI. Having a diagnosis of a primary headache disorder does not preclude you from having a secondary headache. If your headaches change in characteristic, or stop responding to the usual medication, you should bring that to your physician's attention. 

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.