More About Department of Radiology Minus iconIcon indicating subtraction, or that the element can be closed. Plus IconIcon indicating addition, or that the element can be opened. Arrow (down) icon.An arrow icon, usually indicating that the containing element can be opened and closed.

Appropriate Use Criteria for Headache

CMS Priority Clinical Area: Headache - Traumatic and Nontraumatic
MSK Imaging Disease Management Team: NeuroOncology/Head and Neck

Clinical Condition: Any Cancer Diagnosis and Nontraumatic Headache and:

Back to top

Focal Neurologic Deficit

Clinical Condition Any cancer diagnosis with nontraumatic headache and focal neurologic deficit.
Logic Statement <Any Diagnosis of Cancer> AND
<New or Change in Nontraumatic Headache> AND
<Focal Neurologic Deficit>
MSK Continuum of Care Phase
  • Screening
  • Initial cancer detection/diagnosis
  • Surveillance for tumor recurrence
  • Evaluation of complications of therapy
  • Diagnosis of allied/ associated conditions
Appropriate Imaging

Usually Appropriate

  • MRI head without and with IV contrast

Sometimes Appropriate

  • MRI head without contrast
  • CT head without and with IV contrast
  • CT head without IV contrast
  • MRA head without IV contrast
  • MRA head without and with IV contrast
  • CTA head with IV contrast
  • MRV head

Rarely Appropriate

  • Arteriography cervicocerebral
Special Considerations in Oncology Care
  • Patients with known cancer should be scanned when a new headache develops or if the characteristics of a headache change or progress.
  • In the presence of a focal neurologic deficit, imaging should be primarily directed to identify mass lesions, destructive lesions and infiltrative or diffuse lesions.
  • MRI head without and with contrast is usually appropriate as an initial study
  • CT head without contrast can be used as the first imaging modality as a rapid screen, but may be followed by MRI to increase sensitivity and specificity.
  • Noncontrast MRI head is sometimes appropriate as the first imaging modality when contrast is contraindicated, or when clinical factors suggest ischemia
  • CT head with and without contrast is sometimes appropriate if MRI is contraindicated or unavailable.
  • Conditional: MRV head may be indicated as part of initial evaluation if venous infarct or sinus occlusion is suspected.
  • Conditional: MRA head, CTA head may be obtained to evaluate vasculature when vascular disease is suspected.
Evidence

Link to Review of Supporting Evidence

Back to top

History of Brain Radiation

Clinical Condition

Any cancer diagnosis with nontraumatic headache and history of brain radiation.

Logic Statement <Any Diagnosis of Cancer> AND
<New or Change in Nontraumatic Headache> AND
<History of Brain Radiation>
MSK Continuum of Care Phase
  • Therapeutic response assessment
  • Surveillance for tumor recurrence
  • Evaluation of complications of therapy
Appropriate Imaging

Usually Appropriate

  • MRI head without and with contrast
  • MRI head perfusion

Sometimes Appropriate

  • CT head without and with contrast
  • MRI head without IV contrast
  • CT head without contrast
  • FDG PET/CT head
  • MRI spectroscopy

Rarely Appropriate

  • MRA head
  • MRV head
Special Considerations in Oncology Care
  • Patients with known cancer should be scanned when a new headache develops or if the characteristics of a headache change or progress.
  • When such a patient has known history of brain radiation, imaging should be primarily directed to identify and characterize new and/or recurrent mass lesions, destructive lesions and infiltrative or diffuse lesions.
  • MRI head without and with contrast is usually appropriate as an initial study
  • MRI head perfusion is usually appropriate if available and, in conjunction with MRI head, can further characterize new and recurrent lesions.
  • CT head without contrast can be used as the first imaging modality as a rapid screen, but may be followed by MRI to increase sensitivity and specificity.
  • CT head with and without contrast is sometimes appropriate if MRI is contraindicated or unavailable.
  • Conditional: FDG-PET is sometimes appropriate to characterize lesions.
  • Conditional: MR spectroscopy is sometimes appropriate to characterize lesions.
Evidence

Link to Review of Supporting Evidence

Back to top