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
CT venography 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
MR venography 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
MR venography 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
MR venography 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
CT venography 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
MR venography 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
CT venography 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
MR venography 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
MR venography 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
MR venography 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
MR venography 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
CT venography 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
CT venography 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
MR venography 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
MR venography 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
Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below.
Final Tabulations:
A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, …etc.)
Disagree:
The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation.
References:
Lists the references associated with the recommendation
SQ:
Study Quality (1, 2, 3, 4, Good M or Inadequate M) of the references listed.
RRL:
Information on the Relative Radiation Level (RRL) designations can be found here.