Neuroimaging Guidelines for Headache Diagnosis

Diagnostic Approach

The American Academy of Family Physicians recommends neuroimaging, either CT head or MRI brain, as the mandatory first step in diagnosing headaches with red flags, such as new onset headache in a patient with no prior headache history 1
Neuroimaging should be obtained before symptomatic treatment, to rule out secondary causes such as subarachnoid hemorrhage, intracranial mass, or other life-threatening pathology 1

The American Academy of Family Physicians suggests that acute migraine treatment should only be considered after neuroimaging excludes secondary causes 1
First-line acute treatment for migraine includes NSAIDs, such as ibuprofen 400-800mg or naproxen 500-1000mg, or combination therapy with aspirin 250mg + acetaminophen 250mg + caffeine 65mg 2
For moderate-to-severe pain, triptans, such as sumatriptan 50-100mg orally, or 6mg subcutaneous, may be used 2
If nausea is present, metoclopramide 10mg or prochlorperazine 10mg may be added 2
Opioids should be avoided due to the risk of dependency, rebound headaches, and loss of efficacy 2