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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Jordan JE, Flanders AE. Headache and Neuroimaging: Why We Continue to Do It. [Review]. AJNR Am J Neuroradiol. 41(7):1149-1155, 2020 07. Review/Other-Dx N/A To discuss the review of headache and neuroimaging. No results stated in the abstract. 4
2. Gadde JA, Cantrell S, Patel SS, Mullins ME. Neuroimaging of Adults with Headache: Appropriateness, Utilization, and an Economical Overview. [Review]. Neuroimaging Clin N Am. 29(2):203-211, 2019 May. Review/Other-Dx N/A To review and discuss the consideration of imaging adult patients with headache. No results stated in the abstract. 4
3. Kuruvilla DE, Lipton RB. Appropriate use of neuroimaging in headache. [Review]. Curr Pain Headache Rep. 19(6):17, 2015 Jun. Review/Other-Dx N/A To provide guidelines for the appropriate use of neuroimaging in headache. No results stated in abstract. 4
4. Gilbert JW, Johnson KM, Larkin GL, Moore CL. Atraumatic headache in US emergency departments: recent trends in CT/MRI utilisation and factors associated with severe intracranial pathology. Emerg Med J. 2011. Review/Other-Dx 15,062 patient records To estimate recent trends in CT/MRI utilization among patients seeking emergency care for atraumatic headache in the USA and to identify factors associated with a diagnosis of significant intracranial pathology in these patients. Between 1998 and 2008 the percentage of patients presenting to the ED with atraumatic headache who underwent imaging increased from 12.5% to 31.0% (P<0.01) while the prevalence of intracranial pathology among those visits decreased from 10.1% to 3.5% (P<0.05). The length of stay in the ED was 4.6 hours (95% CI: 4.4 to 4.8) for patients with headache who received imaging compared with 2.7 (95% CI: 2.6 to 2.9) for those who did not. Of 18 factors evaluated in patients with headache, 10 were associated with a significantly increased odds of an intracranial pathology diagnosis: age =50 years, arrival by ambulance, triage immediacy <15 minutes, systolic blood pressure =160 mm Hg or diastolic blood pressure =100 mm Hg and disturbance in sensation, vision, speech or motor function including neurological weakness. 4
5. Nesselroth D, Klang E, Soffer S, et al. Yield of head CT for acute findings in patients presenting to the emergency department. Clin Imaging. 73:1-5, 2021 May. Observational-Dx 1536 To evaluate the yield of head CT in the ED in different age groups and different referral indications. Overall, 1536 of adult patients with ED head CT were included. Acute findings were found in 239/1536 (15.5%) of the CTs. The frequency of acute findings increased with age (p = 0.027). The most common acute findings were brain hemorrhage (32.6%), infarct (27.6%), and mass (23%). The top three referral indications were focal neurologic deficit (28%), trauma (24.7%), and headache (17.5%). The rates of positive acute findings for different referral indications were seizure 27%, confusion 20%, syncope 19%, focal neurologic deficit 16%, head injury 15%, headache 12%, and dizziness 8%. 2
6. Salmela MB, Mortazavi S, Jagadeesan BD, et al. ACR Appropriateness Criteria® Cerebrovascular Disease. J Am Coll Radiol 2017;14:S34-S61. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for cerebrovascular disease. No results stated in abstract. 4
7. Policeni B, Corey AS, Burns J, et al. ACR Appropriateness Criteria® Cranial Neuropathy. J Am Coll Radiol 2017;14:S406-S20. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for cranial neuropathy. No results stated in abstract. 4
8. Expert Panel on Neurologic Imaging:, Kirsch CFE, Bykowski J, et al. ACR Appropriateness Criteria R Sinonasal Disease. J. Am. Coll. Radiol.. 14(11S):S550-S559, 2017 Nov. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for sinonasal disease. No results stated in abstract. 4
9. Shih RY, Burns J, Ajam AA, et al. ACR Appropriateness Criteria® Head Trauma: 2021 Update. J Am Coll Radiol 2021;18:S13-S36. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for head trauma. No results stated in abstract. 4
10. Long D, Koyfman A, Long B. The Thunderclap Headache: Approach and Management in the Emergency Department. [Review]. J Emerg Med. 56(6):633-641, 2019 Jun. Review/Other-Dx N/A To evaluate the various conditions that may present with TCH and proposes a diagnostic algorithm for patients with TCH. Patients presenting with TCH require diagnostic evaluation. History and examination are vital in assessing for risk factors for various conditions. Focused testing can assist with diagnosis, with management tailored to the specific diagnosis. 4
11. Malhotra A, Wu X, Gandhi D, Sanelli P. The Patient with Thunderclap Headache. [Review]. Neuroimaging Clin N Am. 28(3):335-351, 2018 Aug. Review/Other-Dx N/A To discuss Thunderclap headache of a patient. No results stated in the abstract. 4
12. Arrigan MT, Heran MKS, Shewchuk JR. Reversible cerebral vasoconstriction syndrome: an important and common cause of thunderclap and recurrent headaches. [Review]. Clin Radiol. 73(5):417-427, 2018 05. Review/Other-Dx N/A To provide a detailed review of this syndrome, its pathophysiology, differential diagnosis, imaging findings, and work-up. To describe the role that high-resolution magnetic resonance imaging (MRI) techniques can have in diagnosing the disease and emphasis the central role that all radiologists have in detecting this important and underdiagnosed condition. No results is stated in the abstract. 4
13. Mortimer AM, Bradley MD, Stoodley NG, Renowden SA. Thunderclap headache: diagnostic considerations and neuroimaging features. [Review]. Clin Radiol. 68(3):e101-13, 2013 Mar. Review/Other-Dx N/A To discuss the diagnostic considerations and neuroimaging features of thunderclap headache No results stated in abstract. 4
14. Kwon R. Calculated Decisions: Ottawa Subarachnoid Hemorrhage Rule. Emerg. med. pract.. 21(2):CD1-2, 2019 Feb 01. Review/Other-Dx N/A To discuss the calculated decisions of the Subarachnoid Hemorrhage Rule. No results is stated in the abstract. 4
15. Godwin SA, Cherkas DS, Panagos PD, Shih RD, Byyny R, Wolf SJ. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache. Annals of Emergency Medicine. 74(4):e41-e74, 2019 10. Review/Other-Dx N/A To address the key issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. No results stated in the abstract. 4
16. Blok KM, Rinkel GJ, Majoie CB, et al. CT within 6 hours of headache onset to rule out subarachnoid hemorrhage in nonacademic hospitals. Neurology. 84(19):1927-32, 2015 May 12. Observational-Dx 760 patients To investigate whether staff radiologists working in nonacademic hospitals can adequately rule out subarachnoid hemorrhage (SAH) on head computed tomography (CT) <6 hours after headache onset. Of 760 included patients, CSF analysis was considered positive for bilirubin in 52 patients (7%). Independent review of these patients' CTs identified one patient (1/52; 2%) with a perimesencephalic nonaneurysmal SAH. Negative predictive value for detection of subarachnoid blood by staff radiologists working in a nonacademic hospital was 99.9% (95% confidence interval 99.3%-100.0%). 2
17. Dubosh NM, Bellolio MF, Rabinstein AA, Edlow JA. Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis. [Review]. Stroke. 47(3):750-5, 2016 Mar. Meta-analysis 882 titles To determine the sensitivity of brain CT using modern scanners (16-slice technology or greater) when performed within 6 hours of headache onset to exclude SAH in neurologically intact patients. A total of 882 titles were reviewed and 5 articles met inclusion criteria, including an estimated 8907 patients. Thirteen had a missed SAH (incidence 1.46 per 1000) on brain CTs within 6 hours. Overall sensitivity of the CT was 0.987 (95% confidence intervals, 0.971-0.994) and specificity was 0.999 (95% confidence intervals, 0.993-1.0). The pooled likelihood ratio of a negative CT was 0.010 (95% confidence intervals, 0.003-0.034). M
18. Alons IME, Goudsmit BFJ, Jellema K, van Walderveen MAA, Wermer MJH, Algra A. Yield of Computed Tomography (CT) Angiography in Patients with Acute Headache, Normal Neurological Examination, and Normal Non Contrast CT: A Meta-Analysis. [Review]. J STROKE CEREBROVASC DIS. 27(4):1077-1084, 2018 Apr. Observational-Dx 88 patients We included 88 patients from our hospital files and 641 patients after literature search. Of 729 patients 54 had a vascular abnormality on CTA (7.4%; 95% confidence interval [CI] 5.5%-9.3%). Abnormalities consisted of aneurysms (n = 42; 5.4%; 95% CI 3.8%-7.0%), CVT (n = 3, .5%), RCVS (n = 4, .5%), Moyamoya syndrome (n = 2, .3%), arterial dissection (n = 2, .3%), and ischemia (n = 1, .1%). Because most of the aneurysms were probably incidental findings, only 12 (1.6%) patients had a clear relation between the headache and CTA findings. The number needed to scan to find an abnormality was 14 overall, and 61 for an abnormality other than an aneurysm. We included 88 patients from our hospital files and 641 patients after literature search. Of 729 patients 54 had a vascular abnormality on CTA (7.4%; 95% confidence interval [CI] 5.5%-9.3%). Abnormalities consisted of aneurysms (n = 42; 5.4%; 95% CI 3.8%-7.0%), CVT (n = 3, .5%), RCVS (n = 4, .5%), Moyamoya syndrome (n = 2, .3%), arterial dissection (n = 2, .3%), and ischemia (n = 1, .1%). Because most of the aneurysms were probably incidental findings, only 12 (1.6%) patients had a clear relation between the headache and CTA findings. The number needed to scan to find an abnormality was 14 overall, and 61 for an abnormality other than an aneurysm. 2
19. da Rocha AJ, da Silva CJ, Gama HP, et al. Comparison of magnetic resonance imaging sequences with computed tomography to detect low-grade subarachnoid hemorrhage: Role of fluid-attenuated inversion recovery sequence. Journal of Computer Assisted Tomography. 30(2):295-303, 2006 Mar-Apr.J Comput Assist Tomogr. 30(2):295-303, 2006 Mar-Apr. Observational-Dx 45 patients To compare computed tomography (CT) with magnetic resonance imaging (MRI) for the presumptive diagnosis and localization of acute and subacute low-grade subarachnoid hemorrhage (SAH). Three of 45 patients had normal CT and MRI scans, and SAH was excluded by lumbar puncture. We demonstrated SAH on CT scans in 28 of 42 (66.6%) patients, T2* sequences in 15 of 42 (35.7%) patients, and FLAIR sequences in 42 of 42 (100%) patients. Fluid-attenuated inversion recovery sequences were superior to CT in 16 of the 26 evaluated regions. 2
20. Ashraf R, Akhtar M, Akhtar S, Manzoor I. Diagnostic accuracy of flair in detection of acute subarachnoid hemorrhage in patients presenting with severe headache. J Neuroradiol. 46(5):294-298, 2019 Sep. Observational-Dx 245 patients To determine diagnostic accuracy of FLAIR in detection of acute subarachnoid hemorrhage in patients presenting with severe headache using lumber puncture as gold standard. Out of 245 cases, 49.39% (n=121) were between 20-55 years of age while 50.61% (n=124) were between 56-70 years of age, mean±sd was calculated as 52.13±10.45 years, 53.88% (n=132) were male while 46.12% (n=113) were females, frequency of acute subarachnoid hemorrhage in patients presenting with severe headache was recorded as 5.71%(n=14), diagnostic accuracy of FLAIR in detection of acute subarachnoid hemorrhage in patients presenting with severe headache taking lumbar puncture as gold standard as 78.57% sensitivity, 96.53% specificity, 57.89% positive predictive value, 98.67% negative predictive value and accuracy rate was calculated as 95.29%. 2
21. Honningsvag LM, Hagen K, Haberg A, Stovner LJ, Linde M. Intracranial abnormalities and headache: A population-based imaging study (HUNT MRI). Cephalalgia. 36(2):113-21, 2016 Feb. Observational-Dx 864 patients To evaluate the relationship between intracranial abnormalities and headache among middle-aged adults in the general population. Intracranial abnormalities were more common in headache sufferers than in headache-free individuals (29% vs. 22%, respectively; p = 0.041). Adjusted multivariate analyses revealed that those with tension-type headache had higher odds of having minor abnormalities (odds ratio, 2.13; 95% confidence interval = 1.18-3.85). This association disappeared when those with only white matter hyperintensities were removed from the analysis. 3
22. GBD Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390:1211-59. Review/Other-Dx N/A To provide a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016. Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8-75·9 million [7·2%, 6·0-8·3]), 45·1 million (29·0-62·8 million [5·6%, 4·0-7·2]), 36·3 million (25·3-50·9 million [4·5%, 3·8-5·3]), 34·7 million (23·0-49·6 million [4·3%, 3·5-5·2]), and 34·1 million (23·5-46·0 million [4·2%, 3·2-5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3-3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0-11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer's disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862-11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018-19 228). 4
23. . Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 38(1):1-211, 2018 01. Review/Other-Dx N/A To review the classifications headache disorders. No results stated in the abstract 4
24. Vijiaratnam N, Barber D, Lim KZ, et al. Migraine: Does aura require investigation?. Clinical Neurology & Neurosurgery. 148:110-4, 2016 Sep.Clin Neurol Neurosurg. 148:110-4, 2016 Sep. Review/Other-Dx 505 patients To analyse the demographics of migraine presentations to our hospital and the yield of imaging in our centre to help guide future approaches to these patients. We found patients with aura were more likely to have hypercholesterolemia (12% vs 7%, p=0.05). Patients with aura were more likely to be evaluated with imaging (CT brain (70% vs 41% p<0.0001) and MRI brain (44% vs 17% p<0.0001)). The patients investigated with imaging had no clinically significant findings. 21% of patients with aura were investigated with carotid Doppler studies. Only 1 patient had an abnormal result. Patients with white matter hyperintensities were older (51 vs 39 years; p<0.0001) and were more likely to have Hypertension (29% vs 14% p=0.019), Hypercholesterolemia (29% vs 11% p=0.003) and T2DM (16% vs 4% p=0.011). 4
25. Wang R, Liu R, Dong Z, et al. Unnecessary Neuroimaging for Patients With Primary Headaches. Headache. 59(1):63-68, 2019 01. Observational-Dx 1070 patients To compare the neuroimaging findings of headache patients and healthy controls. All the significant abnormalities were found using MRI scans. Significant abnormalities were identified in 4 primary headache patients (0.58%) and 5 healthy controls (0.73%); the rate of significant abnormalities was not significant different between both groups (P > .05). 2
26. Sempere AP, Porta-Etessam J, Medrano V, et al. Neuroimaging in the evaluation of patients with non-acute headache. Cephalalgia. 2005; 25(1):30-35. Observational-Dx 1,876 consecutive patients Prospective study to estimate the frequency of significant intracranial lesions in patients with headache and to determine the clinical variables helpful in identifying patients with intracranial lesions. Neuroimaging studies detected significant lesions in 22 patients [1.2%, 95% CI, 0.7, 1.8]. The rate of significant intracranial abnormalities in patients with headache and normal neurological examination was 0.9% (95% CI, 0.5, 1.4). The only clinical variable associated with a higher probability of intracranial abnormalities was neurological examination. The proportion of patients with headache and intracranial lesions is relatively small, but neither neurological examination nor the features in the clinical history permit authors to rule out such abnormalities. 3
27. Russo A, Silvestro M, Tessitore A, Tedeschi G. Advances in migraine neuroimaging and clinical utility: from the MRI to the bedside. [Review]. Expert rev. neurotherapeutics. 18(7):533-544, 2018 07. Review/Other-Dx N/A To review the recent advances in functional neuroimaging, the consequent progress in the knowledge of migraine pathophysiology and their putative application and impact in the clinical setting. No results stated in the abstract. 4
28. Wolf ME, Okazaki S, Eisele P, et al. Arterial Spin Labeling Cerebral Perfusion Magnetic Resonance Imaging in Migraine Aura: An Observational Study. J STROKE CEREBROVASC DIS. 27(5):1262-1266, 2018 May. Observational-Dx 4 patients To assess changes in cerebral perfusion during MA using arterial spin labeling (ASL) perfusion magnetic resonance imaging. In all patients, regional perfusion changes were detected in the acute phase. These abnormalities did not respect the boundaries of major cerebral vascular territories but overlapped onto adjoining regions. During MA, adjacent hypoperfused and hyperperfused areas were found, whereas during headache, regional hyperperfusion only was observed. Perfusion abnormalities normalized on follow-up. 4
29. Ferraro S, Nigri A, Bruzzone MG, et al. Cluster headache: insights from resting-state functional magnetic resonance imaging. [Review]. Neurol Sci. 40(Suppl 1):45-47, 2019 May. Review/Other-Dx N/A To provide a review of the few resting-state functional magnetic resonance imaging studies investigating the hypothalamic network contributing to a deeper comprehension of this neurological disorder. No results stated in the abstract. 4
30. Burish M. Cluster Headache and Other Trigeminal Autonomic Cephalalgias. [Review]. Continuum. 24(4, Headache):1137-1156, 2018 08. Observational-Dx N/A To cover the clinical features, differential diagnosis, and management of the trigeminal autonomic cephalalgias (TACs). New classifications for the TACs have two important updates; chronic cluster headache is now defined as remission periods lasting less than 3 months (formerly less than 1 month), and hemicrania continua is now classified as a TAC (formerly classified as other primary headache). The first-line treatments of TACs have not changed in recent years: cluster headache is managed with oxygen, triptans, and verapamil; paroxysmal hemicrania and hemicrania continua are managed with indomethacin; and SUNCT and SUNA are managed with lamotrigine. However, advancements in neuromodulation have recently provided additional options for patients with cluster headache, which include noninvasive devices for abortive therapy and invasive devices for refractory cluster headache. Patient selection for these devices is key. 2
31. Favier I, van Vliet JA, Roon KI, et al. Trigeminal autonomic cephalgias due to structural lesions: a review of 31 cases. Arch Neurol. 2007;64(1):25-31. Review/Other-Dx 31 Cases To review the literature and 4 new cases of a trigeminal autonomic cephalgias or trigeminal autonomic cephalgias-like syndrome associated with a structural lesion in which symptoms resolved after treatment of the lesion. Even typical trigeminal autonomic cephalgiass can be caused by an underlying lesion. Clinical warning signs and symptoms are relatively rare. 4
32. Goadsby PJ. Trigeminal autonomic cephalalgias. Continuum (Minneap Minn) 2012;18:883-95. Review/Other-Dx N/A To discuss the clinical manifestations and differential diagnosis of the trigeminal autonomic cephalalgias (TACs). TACs comprise a subgroup of primary headache disorders presenting with lateralized, often severe, pain accompanied by cranial autonomic features. The key syndromes are cluster headache, paroxysmal hemicrania, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)/short-lasting unilateral neuralgiform headache attacks with cranial autonomic features (SUNA), and hemicrania continua. Lateralization of symptoms and signs is the key feature differentiating the TACs and migraine. When diagnosing a TAC, it is appropriate to consider underlying pituitary or pituitary region pathology. Cluster headache responds to oxygen and parenteral triptans, with verapamil having the most success for prevention. Paroxysmal hemicrania responds to indomethacin. SUNCT/SUNA responds to lamotrigine and topiramate. Hemicrania continua responds to indomethacin. 4
33. de Coo IF, Wilbrink LA, Haan J. Symptomatic Trigeminal Autonomic Cephalalgias. [Review]. Curr Pain Headache Rep. 19(8):39, 2015 Aug. Review/Other-Dx 19 cases To review the recent insights in symptomatic Trigeminal autonomic cephalalgias (TACs) by comparing and categorizing newly published cases. No results stated in abstract 4
34. Mitsikostas DD, Ashina M, Craven A, et al. European Headache Federation consensus on technical investigation for primary headache disorders. J HEADACHE PAIN. 17:5, 2015. Review/Other-Dx N/A To provide guidelines for technical investigation for primary headache disorders. No results stated in abstract. 4
35. Maralani PJ, Hassanlou M, Torres C, et al. Accuracy of brain imaging in the diagnosis of idiopathic intracranial hypertension. Clin Radiol. 67(7):656-63, 2012 Jul. Observational-Dx 43 patients; 43 control subjects To investigate the accuracy of individual and combinations of signs on brain magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) in the diagnosis of idiopathic intracranial hypertension (IIH). Partially empty sella (specificity 95.3%, p < 0.0001), flattening of the posterior globes (specificity 100%, p < 0.0001), and CSS <4 (specificity 100%, p < 0.0001) were highly specific for IIH. The presence of one sign, or any combination, significantly increased the odds of a diagnosis of IIH (LR+ 18.5 to 46, p < 0.0001). Their absence, however, did not rule out IIH 2
36. Hoffmann J, Mollan SP, Paemeleire K, Lampl C, Jensen RH, Sinclair AJ. European headache federation guideline on idiopathic intracranial hypertension. J HEADACHE PAIN. 19(1):93, 2018 Oct 08. Review/Other-Dx N/A To discuss the European headache federation guideline on idiopathic intracranial hypertension Diagnostic uncertainty, headache morbidity and visual loss are among the highest concerns of clinicians and patients in this disease area. Research in this field is infrequent due to the rarity of the disease and the lack of understanding of the underlying pathology. 4
37. Sobri M, Lamont AC, Alias NA, Win MN. Red flags in patients presenting with headache: clinical indications for neuroimaging. Br J Radiol 2003;76:532-5. Observational-Dx 111 patients To evaluate clinical features in patients with headache using neuroimaging as a screening tool for intracranial pathology. A retrospective study of 111 patients was performed and the outcomes were divided into positive and negative. Abnormal neuroimaging was present in 39 patients. Results were analysed using the Logistic Regression model. Sensitivity and specificity of red flags were analysed to establish the cut-off point to predict abnormal neuroimaging and a receiver operating characteristic (ROC) curve plotted to show the sensitivity of the diagnostic test. Three red flag features proved to be statistically significant with the p-value of less than 0.05 on both univariate and multivariate analysis. These were: paralysis; papilloedema; and "drowsiness, confusion, memory impairment and loss of consciousness". In addition, if three or more red flags from the list were present, this showed strong indication of abnormal neuroimaging, from cut-off point of ROC curve (area under the curve =0.76). 3
38. Hoffmann J, Huppertz HJ, Schmidt C, et al. Morphometric and volumetric MRI changes in idiopathic intracranial hypertension. Cephalalgia. 33(13):1075-84, 2013 Oct. Observational-Dx 25 patients To establish imaging features of idiopathic intracranial hypertension (IIH) by using state-of-the-art magnetic resonance (MR) imaging together with advanced post-processing techniques and correlated imaging findings to clinical scores. So-called 'empty sella' and optic nerve sheath distension were identified as reliable imaging signs in IIH. Posterior globe flattening turned out as a highly specific but not very sensitive sign. No abnormalities of the lateral ventricles were observed. These morphometric results could be confirmed using MR volumetry (VBM). Clinical symptoms did not correlate with an increase in lumbar opening pressure. 2
39. Sparaco M, Feleppa M, Bigal ME. Cerebral Venous Thrombosis and Headache--A Case-Series. Headache. 55(6):806-14, 2015 Jun. Observational-Dx 25 adult patients To report a case-series of Cerebral Venous Thrombosis (CVT), focusing on headache characteristics. Headache was reported by 23 out of 25 (92%) of participants, being by far the most frequent symptom. It was the sole manifestation in nearly one third of the patients (8/25, 32.0%). Headache was typically severe (19/23, 82.6%) and throbbing (16/23, 69.5%), with sudden onset (13/23, 56.5%) and non-remitting (20/23, 86.9%) characteristics. The sinus most frequently involved was the transverse sinus (24/25, 96.0%), either alone or in association with other sinuses. 2
40. Friedman DI. Headaches in Idiopathic Intracranial Hypertension. [Review]. J Neuroophthalmol. 39(1):82-93, 2019 03. Review/Other-Dx N/A To propose mechanisms by which IIH produces both acute and ongoing headache. The article To analyze the literature regarding medical and procedural therapies for IIH, apropos to their effectiveness for treating headaches. To propose strategies to use in clinical practice, incorporating treatments used for the primary headache disorders of migraine and tension-type headache, the most common phenotypes of IIH-associated headache. Recommendations provided consider a holistic approach to the problem based on existing guidelines and clinical experience. 4
41. Dinia L, Bonzano L, Albano B, et al. White matter lesions progression in migraine with aura: a clinical and MRI longitudinal study. Journal of Neuroimaging. 23(1):47-52, 2013 Jan. Observational-Dx 41 patients To evaluate longitudinal changes in white matter lesions (WMLs) in migraineurs with aura, by magnetic resonance imaging (MRI), and to correlate WMLs modifications with patients' clinical characteristics. WMLs were present in 26 subjects (63.4%) at baseline MRI. At follow-up a total of 8 patients had new WMLs (19.5%). There was a significant correlation between aura duration and number of new WMLs, and between the number of migraine attacks with aura and new WMLs. 2
42. Reis DJ. Brain-stem mechanisms governing resting and reflex tone of precapillary vessels. J Cardiovasc Pharmacol 1985;7 Suppl 3:S160-6. Observational-Dx N/A To discuss the brain-stem mechanisms governing resting and reflex tone of precapillary vessels. No results stated in the abstract. 4
43. Bond KM, Benson JC, Cutsforth-Gregory JK, Kim DK, Diehn FE, Carr CM. Spontaneous Intracranial Hypotension: Atypical Radiologic Appearances, Imaging Mimickers, and Clinical Look-Alikes. [Review]. AJNR Am J Neuroradiol. 41(8):1339-1347, 2020 08. Review/Other-Dx N/A To discuss conditions that mimic the radiologic and clinical presentation of spontaneous intracranial hypotension as well as other disorders that CSF leaks can imitate No results stated in the abstract. 4
44. Perez-Vega C, Robles-Lomelin P, Robles-Lomelin I, Garcia Navarro V. Spontaneous intracranial hypotension: key features for a frequently misdiagnosed disorder. [Review]. Neurological Sciences. 41(9):2433-2441, 2020 Sep. Review/Other-Dx N/A To discuss the key features for a frequently misdiagnosed disorder of spontaneous intracranial hypotension. No results stated in the abstract. 4
45. Amrhein TJ, Kranz PG. Spontaneous Intracranial Hypotension: Imaging in Diagnosis and Treatment. [Review]. Radiologic Clinics of North America. 57(2):439-451, 2019 Mar. Review/Other-Dx N/A To review the role of imaging in the diagnosis, management, and treatment of spontaneous intracranial hypotension (SIH). No results state din the abstract. 4
46. Kim BR, Lee JW, Lee E, Kang Y, Ahn JM, Kang HS. Utility of heavily T2-weighted MR myelography as the first step in CSF leak detection and the planning of epidural blood patches. Journal of Clinical Neuroscience. 77:110-115, 2020 Jul. Observational-Dx 26 patients To to assess epidural blood patch (EBP) treatment outcome when using HT2W-MRM as the primary modality for detecting CSF leak and planning EBP placement in routine clinical practice. Since 2018, patients at our institute suspected of having CSF leak, routinely HT2W-MRM instead of CT myelography to determine presence of the leak and identify the EBP target site. Fifty-nine consecutive patients suspected of having a CSF leak underwent HT2W-MRM. After excluding patients with subdural hematoma and poor image quality, 26 (10 men, 16 women; mean age 44.92 ± 12.6 years) patients were included in this study. Patients received EBP on the basis of HT2W-MRM assessments and clinical assessment. Imaging findings and clinical outcome were evaluated. CSF leak was identified in 21 patients (80.8%, 21/26) based HT2W-MRM. Most cases were graded on a confidence scale as CSF leak definitely (n = 13) or probably (n = 3) present. Successful clinical EBP treatment was achieved in 14 of 17 patients (82.4%) after first targeted EBP, and patient symptoms significantly improved after treatment (numerical rating score 6.4 before EBP, 1.3 after EBP, P < 0.001). HT2W-MRM based EBP are the rational and effective choices for CSF leak treatment in routine clinical practice. 2
47. Robbins MS, Farmakidis C, Dayal AK, Lipton RB. Acute headache diagnosis in pregnant women: a hospital-based study. Neurology. 85(12):1024-30, 2015 Sep 22. Observational-Dx 140 patients To characterize demographic and clinical features in pregnant women presenting with acute headache, and to identify clinical features associated with secondary headache. The 140 women had a mean age of 29 +/- 6.4 years and often presented in the third trimester (56.4%). Diagnoses were divided into primary (65.0%) and secondary (35.0%) disorders. The most common primary headache disorder was migraine (91.2%) and secondary headache disorders were hypertensive disorders (51.0%). The groups were similar in demographics, gestational ages, and most headache features. In univariate analysis, secondary headaches were associated with a lack of headache history (36.7% vs 13.2%, p = 0.0012), seizures (12.2% vs 0.0%, p = 0.0015), elevated blood pressure (55.1% vs 8.8%, p < 0.0001), fever (8.2% vs 0.0%, p = 0.014), and an abnormal neurologic examination (34.7% vs 16.5%, p = 0.014). In multivariate logistic regression, elevated blood pressure (odds ratio [OR] 17.0, 95% confidence interval [CI] 4.2-56.0) and a lack of headache history (OR 4.9, 95% CI 1.7-14.5) had an increased association with secondary headache, while psychiatric comorbidity (OR 0.13, 95% CI 0.021-0.78) and phonophobia (OR 0.29, 95% CI 0.09-0.91) had a reduced association with secondary headache. 3
48. Raffaelli B, Neeb L, Israel-Willner H, et al. Brain imaging in pregnant women with acute headache. J Neurol. 265(8):1836-1843, 2018 Aug. Review/Other-Dx 151 patients To identify anamnestic and clinical predictors for pathological brain imaging findings in pregnant women suffering from acute headache Half of the patients (50.3%) underwent brain imaging, mainly magnetic resonance imaging (MRI) including venography (53.9%) or MRI including both venography and arteriography (31.6%). Symptomatic pathological results could be observed in 27.6% of the patients with a brain scan. Patients in the first trimester with acute headache had a statistically higher risk for a symptomatic pathological imaging finding (p = 0.024). Strong pain intensity, a reduced level of consciousness and seizures were significantly associated with a symptomatic pathological imaging outcome across all stages of pregnancy. 4
49. Shobeiri E, Torabinejad B. Brain magnetic resonance imaging findings in postpartum headache. Neuroradiol. j.. 32(1):4-9, 2019 Feb. Observational-Dx 102 patients To determine the frequency of abnormal magnetic resonance imaging findings in patients with postpartum headache and related factors Abnormal magnetic resonance imaging findings were observed in 42 of 102 patients (41.2%, 95% confidence interval = 31.6 to 50.7%). The most common finding was sinusitis (10 of 42 patients, 23.8%, 95% confidence interval = 15.5 to 32%). Then, posterior reversible encephalopathy syndrome (six of 42 cases, 14.2%, 95% confidence interval = 7.4 to 20.9%), cerebral venous thrombosis (four of 42 cases, 9.5%, 95% confidence interval = 3.8 to 15.1%), and subarachnoid hemorrhage (four of 42 cases, 9.5%, 95% confidence interval = 3.8 to 15.1%) were most prevalent findings. Convulsions (odds ratio of 3.39) and initiation of headache earlier than 5 days postpartum (odds ratio of 0.29) were significant predictive factors. 1
50. Molina-Botello D, Rodriguez-Sanchez JR, Cuevas-Garcia J, et al. Pregnancy and brain tumors; a systematic review of the literature. J Clin Neurosci. 86:211-216, 2021 Apr. Review/Other-Dx 43 articles To give an updated review in the literature on the adequate treatment of brain tumors during pregnancy and the anesthetic management during the definite treatment. No results stated in the abstract. 4
51. Negro A, Delaruelle Z, Ivanova TA, et al. Headache and pregnancy: a systematic review. [Review]. J HEADACHE PAIN. 18(1):106, 2017 Oct 19. Review/Other-Dx 18 articles To summarize the existing data on headache and pregnancy with a scope on clinical headache phenotypes, treatment of headaches in pregnancy and effects of headache medications on the child during pregnancy and breastfeeding, headache related complications, and diagnostics of headache in pregnancy. Headache during pregnancy can be both primary and secondary, and in the last case can be a symptom of a life-threatening condition. No results stated in the abstract. 4
52. Robbins MS. Headache in Pregnancy. [Review]. Continuum. 24(4, Headache):1092-1107, 2018 08. Review/Other-Dx N/A To discuss about headache in pregnancy. No results stated in the abstract. 4
53. Kernick DP, Ahmed F, Bahra A, et al. Imaging patients with suspected brain tumour: guidance for primary care. Br J Gen Pract. 2008;58(557):880-885. Review/Other-Dx N/A Review guidance for imaging of patients with suspected brain tumor. Study suggests management for three levels of risk of tumor: red flags >1%; orange flags 0.1-1%; and yellow flags <0.1% but above the background population rate of 0.01%. Clinical presentations are stratified into these 3 groups. Important secondary causes of headache where imaging is normal should not be overlooked, and normal investigation does not eliminate the need for follow-up or appropriate management of headache. 4
54. Clarke CE, Edwards J, Nicholl DJ, Sivaguru A. Imaging results in a consecutive series of 530 new patients in the Birmingham Headache Service. Journal of Neurology. 257(8):1274-8, 2010 Aug.J Neurol. 257(8):1274-8, 2010 Aug. Review/Other-Dx 530 patients To review imaging results in a consecutive series of 530 new patients in the Birmingham Headache Service. Five hundred thirty (14.5%) underwent imaging with large differences in the proportion referred by each consultant. There were more insignificant abnormalities on MRI (46%) than CT (28%). There were 11 significantly abnormal results (2.1% of those imaged). Significant abnormalities were found in patients diagnosed with migraine in 1.2% and in 0.9% of those with tension-type headache. Significant abnormalities in those suspected to have an intracranial abnormality occurred in 5.5%. This supports the practice of selecting patients with suspicious findings for imaging, rather than imaging all patients. 4
55. Do TP, Remmers A, Schytz HW, et al. Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. [Review]. Neurology. 92(3):134-144, 2019 01 15. Review/Other-Dx N/A To discuss the incidence and prevalence of secondary headaches as well as the data on sensitivity, specificity, and predictive value of red flags for secondary headaches. No results stated in the abstract. 4
56. Holle D, Obermann M. The role of neuroimaging in the diagnosis of headache disorders. Therapeutic Advances in Neurological Disorders. 6(6):369-74, 2013 Nov.Ther. adv. neurol. disord.. 6(6):369-74, 2013 Nov. Review/Other-Dx 3026 scans of patients To review the role of neuroimaging in the diagnosis of headache disorders. No results stated in abstract. 4
57. Mehta A, Danesh J, Kuruvilla D. Cerebral Venous Thrombosis Headache. [Review]. Curr Pain Headache Rep. 23(7):47, 2019 May 30. Review/Other-Dx N/A To characterize Cerebral venous thrombosis (CVT), describe the headache pattern, and, finally, provide an update to date review of diagnostic and treatment options for this condition. CVT is a very difficult disease to diagnose due to the variability in both patient presentation and imaging findings. Recent literature has attempted to standardize its risk factors, diagnosis, and treatment modalities. Additionally, new laboratory studies are being investigated for CVT patients who present with isolated headaches. CVT is a debilitating disease requiring immediate medical or surgical intervention. Because the disease can mask as a multitude of neurological deficits, patients are not properly diagnosed. Headache is the most common patient presentation. The quality of this headache is highly variable with no specific location or pattern. New literature has provided insight into potential diagnostic and treatment options for CVT patients. However, further large-scale cohort studies are necessary to standardize the care for this disease. 4
58. Gaughran CG, Tubridy N. Headaches, neurologists and the emergency department. Ir Med J. 107(6):168-71, 2014 Jun. Observational-Dx 543 patients To claim that headache management can be improved by evaluating current emergent care. A total of 543/8,759 had a neurological condition. The most common conditions were headaches (42% or 227 cases), cerebrovascular problems (26%) and seizures (17%). No 'usual headache' patterns showed abnormal imaging. In contrast, those with 'sudden-onset' type or clinical findings had an abnormal scan 17% of the time. Of the MRIs ordered, one-quarter changed management. On discharge, 39% of patients left without a specific headache diagnosis. 3
59. Eller M, Goadsby PJ. MRI in headache. [Review]. Expert rev. neurotherapeutics. 13(3):263-73, 2013 Mar. Review/Other-Dx N/A To review the magnetic resonance imaging (MRI) in headache. No results stated in abstract. 4
60. Wang HZ, Simonson TM, Greco WR, Yuh WT. Brain MR imaging in the evaluation of chronic headache in patients without other neurologic symptoms. Acad Radiol 2001;8:405-8. Review/Other-Dx 402 patients To investigate the use of magnetic resonance (MR) imaging of the brain in adult patients with a primary complaint of chronic headache and no other neurologic symptoms or findings and determined the yield and MR predictors of major abnormalities in these patients. Major abnormalities were found in 15 patients (3.7%), consisting of seven women (2.4%) and eight men (6.9%). Major abnormalities were found in 0.6% of those with migraine headaches, 1.4% with tension headaches, none with mixed migraine and tension headaches, 14.1% with atypical headaches, and 3.8% with other types of headaches. Multivariate analysis showed that the atypical headache type was the most significant predictor of major abnormality. 4
61. Choosing Wisely® An initiative of the ABIM Foundation. American College of Radiology. Five Things Physicians and Patients Should Question.  Available at: http://www.choosingwisely.org/societies/american-college-of-radiology/. Review/Other-Dx N/A To discuss the Five Things Physicians and Patients Should Question. Major abnormalities were found in 15 patients (3.7%), consisting of seven women (2.4%) and eight men (6.9%). Major abnormalities were found in 0.6% of those with migraine headaches, 1.4% with tension headaches, none with mixed migraine and tension headaches, 14.1% with atypical headaches, and 3.8% with other types of headaches. Multivariate analysis showed that the atypical headache type was the most significant predictor of major abnormality. 4
62. Goldstein L, Laytman T, Steiner I. Is Head Computerized Tomography Indicated for the Workup of Headache in Patients with Intact Neurological Examination. Eur Neurol. 80(5-6):341-344, 2018. Observational-Dx 422 patients To discuss the role of neuroimaging in the investigation of adult patients presenting to the ED with nontraumatic headache. In total, 422 patients were included. About 43.4% of scans were normal. Most abnormal findings were sinusitis (148 patients, 35%) or ischemic changes. Seven CT scans (1.6%) showed clinically significant findings requiring an immediate change in management. 3
63. American College of Radiology. ACR–SPR Practice Parameter for the Safe and Optimal Performance of Fetal Magnetic Resonance Imaging (MRI). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/mr-fetal.pdf Review/Other-Dx N/A To promote safe and optimal performance of fetal magnetic resonance imaging (MRI). No abstract available. 4
64. American College of Radiology. ACR-SPR Practice Parameter for Imaging Pregnant or Potentially Pregnant Patients with Ionizing Radiation. Available at: http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Pregnant_Patients.pdf. Review/Other-Dx N/A To assist practitioners in providing appropriate radiologic care for pregnant or potentially pregnant adolescents and women by describing specific training, skills and techniques. No abstract available. 4
65. American College of Radiology. ACR-ACOG-AIUM-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetrical Ultrasound. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/us-ob.pdf Review/Other-Dx N/A To promote the safe and effective use of diagnostic and therapeutic radiology by describing the key elements of standard ultrasound examinations in the first, second, and third trimesters of pregnancy. No abstract available. 4
66. American College of Radiology. ACR Committee on Drugs and Contrast Media. Manual on Contrast Media. Available at: https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf. Review/Other-Dx N/A Guidance document to assist radiologists in recognizing and managing the small but real risks inherent in the use of contrast media. No abstract available. 4
67. American College of Radiology. ACR Committee on MR Safety. 2024 ACR Manual on MR Safety. Available at: https://www.acr.org/-/media/ACR/Files/Radiology-Safety/MR-Safety/Manual-on-MR-Safety.pdf. Review/Other-Dx N/A Guidance document to promote the use of magnetic resonance (MR) safe practices. No abstract available. 4
68. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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