1. Headaches: An Evidence Based Imaging Approach Jorge A Vidal, MD Adjunct Professor of Radiology Edgar Colon Negron, MD Director Diagnostic Radiology UPR-RCM

3. Magnetic Resonance Imaging (MRI)

4. Digital Substraction Angiography (DSA)

5. Positron Emission Tomography (PET)

6. Single Positron Emission Computed Tomography (SPECT)

7. Ultrasound (US)

8. Radiographs

10. Magnetic Resonance Imaging (MRI)

11. Digital Substraction Angiography (DSA)

12. Positron Emission Tomography (PET)

13. Single Positron Emission Computed Tomography (SPECT)

14. Ultrasound (US)

15. Radiographs

18. Space-occupying lesions

19. MDCT can do angiography

21. HIGH RADIATION DOSE

22. Costly $$, but lower than MRI

23. Subdural Hematoma

26. Infections, inflammatory processes

27. Physiologic information (Spectroscopy)

29. Costly $$$

30. Long imaging time

31. Aneurysms

32. MR Spectroscopy

37. High radiation dose

40. Epilepsy studies

41. Cancer and other tumors

42. HIGH RADIATION DOSE

44. Radiographs There is NO appropriate reason for the use of skull films for the evaluation of headaches!

47. Pregnant?

48. History of cancer, rapid weight loss?

49. Neurological deficits or new symptoms?

50. Recent travel destinations?

53. “ Worst headache of my life”

54. In some studies up to 47% had a Subarachnoid hemorrhage.

56. Subarachnoid Hemorrhage

57. Aneurysm

62. CTA and MRA

64. New-onset headache in temple region

65. Tender superficial temporal artery

67. Temporal Arteritis Copyright © 2007 by the American Roentgen Ray Society Bley, T. A. et al. Am. J. Roentgenol. 2005;184:283-287

69. Assess for neurological symptoms

71. Hydrocephalus

73. Extra-axial Mass

74. Extra-axial Mass

75. Sellar Mass

77. Lymphoma

78. Lymphoma

80. Toxoplasmosis

85. Pregnant patients

86. Retina