American College of Radiology
ACR Appropriateness Criteria®

Headache–Child

Variant 1: Child. Primary headache. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI head without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 1 1 7 3 3 0 0 0 0
CT head without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 6 2 3 1 1 1 1 0 0
CTA head with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 13 1 1 0 0 0 0 0 0
CT head with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 9 3 3 0 0 0 0 0 0
CT head without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 11 1 2 1 0 0 0 0 0
Arteriography cerebral Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 0 0 0 0 0 0 0 0
MRA head without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 11 1 0 2 0 1 0 0 0
MRI head without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 8 3 1 1 1 0 0 1 0
Radiography skull Usually not appropriate ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 15 0 0 0 0 0 0 0 0
CTV head with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 3 0 0 0 0 0 0 0
MRV head without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 11 1 2 1 0 0 0 0 0
MRV head with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 1 1 13 2 0 0 0 0 0 0 0
Variant 2: Child. Secondary headache. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI head without IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 2 1 3 6 3
MRI head without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 7 7 0 0 0 1 1 3 4 4 2
CT head without IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 0 0 6 4 3 2 0 0
MRA head without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 0 2 0 5 6 1 1 0 0
MRV head without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 0 2 1 4 7 1 0 0 0
CTV head with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 1 2 2 7 2 1 0 0 0
CTA head with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 4 4 0 3 3 3 6 0 0 0 0
MRV head with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 3 3 2 3 4 0 0 0 0
Arteriography cerebral Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 3 5 1 3 2 1 0 0 0
CT head with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 2 3 1 1 1 0 0 0
Radiography skull Usually not appropriate ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 13 0 1 0 1 0 0 0 0
CT head without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 9 1 1 3 0 0 1 0 0
Variant 3: Child. Sudden severe headache (thunderclap headache). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT head without IV contrast Usually appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 8 8 0 0 0 0 0 0 1 7 7
MRA head without IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 7 7 0 0 1 1 4 0 5 3 1
MRI head without IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 7 7 0 0 1 1 3 2 3 3 2
CTA head with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 5 5 0 0 1 2 5 0 5 2 0
CT head with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 6 1 5 1 0 0 2 0 0
CT head without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 5 0 5 1 2 1 1 0 0
CTV head with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 1 4 5 1 0 1 0 0
MRV head without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 3 3 3 2 3 0 1 0 0
MRI head without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 3 3 1 2 5 3 3 1 0 0 0
Arteriography cerebral Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 4 4 3 2 0 1 1 0 0
MRV head with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 2 6 2 5 2 0 0 0 0 0
Radiography skull Usually not appropriate ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 15 0 0 0 0 0 0 0 0
Variant 4: Child. Headache attributed to infection. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI head without and with IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 0 0 2 5 7
CT head with IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 6 6 0 0 1 0 3 8 3 0 0
CT head without IV contrast May be appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 0 1 0 4 9 0 1 0 0
MRV head without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 5 5 0 2 2 1 8 2 0 0 0
MRA head without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 4 4 0 1 2 6 6 0 0 0 0
MRI head without IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 4 4 0 3 3 4 3 2 0 0 0
MRV head with IV contrast May be appropriate O 0 mSv O 0 mSv [ped] 4 4 2 3 1 3 5 1 0 0 0
CTA head with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 3 3 3 2 3 1 0 0 0
CT head without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 6 2 2 2 2 0 1 0 0
CTV head with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 2 6 3 2 1 1 0 0 0
Arteriography cerebral Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 10 3 2 0 0 0 0 0 0
Radiography skull Usually not appropriate ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 15 0 0 0 0 0 0 0 0
Variant 5: Child. Headache attributed to remote trauma. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
MRI head without IV contrast Usually appropriate O 0 mSv O 0 mSv [ped] 8 8 0 0 0 1 3 1 1 8 1
CT head without IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 2 4 3 5 0 1 0 0 0
CTV head with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 6 1 0 0 1 0 0 0
CTA head with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 4 5 2 3 1 0 0 0 0
MRV head without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 2 6 5 2 0 2 0 0 0 0
MRA head without IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 2 5 4 3 2 0 1 0 0 0
MRI head without and with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 2 5 4 2 1 1 2 0 0 0
MRV head with IV contrast Usually not appropriate O 0 mSv O 0 mSv [ped] 2 2 7 6 1 1 0 0 0 0 0
Arteriography cerebral Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 12 2 0 1 0 0 0 0 0
CT head with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 1 1 8 3 1 0 1 1 1 0 0
CT head without and with IV contrast Usually not appropriate ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 8 2 1 1 2 1 0 0 0
Radiography skull Usually not appropriate ☢ <0.1 mSv ☢☢ 0.03-0.3 mSv [ped] 1 1 12 1 1 1 0 0 0 0 0
Appendix Key

A more complete discussion of the items presented below can be found by accessing the supporting documents at the designated hyperlinks.

Appropriateness Category:The panel’s recommendation for a procedure based on the assessment of the risks and benefits of performing the procedure for the specified clinical scenario.

SOE: Strength of Evidence. The assessment of the amount and quality of evidence found in the peer reviewed medical literature for an appropriateness recommendation.

  • References: The citation number and PMID for the reference(s) associated with the recommendation.
  • Study Quality: The assessment of the quality of an individual reference based on the number of study quality elements described in the reference.

RRL: Relative Radiation Level. A population based assessment of the amount of radiation a typical patient may be exposed to during the specified procedure.

Rating: The final rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Median: The median rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Final tabulations: A histogram showing the number of panel members who rated the procedure as noted in the column heading (ie, 1, 2, 3, etc.).

Additional supporting documents about the AC methodology and processes can be found at www.acr.org/ac.