BASH Guideline

1.2 The role of imaging in headache

People suffering from headache can be anxious about the possibility of a brain tumour. Outside of an emergency setting, current data indicates that the risk of finding serious secondary pathology in patients with isolated headache and a normal neurological examination is similar to that in people who do not have headache (Kernick et al., 2008; Kurth et al., 2015; Sempere et al., 2005; Weber & Knopf, 2006).

Normal imaging can reduce subsequent health care utilisation in the short term (less than one year) presumably because of reassurance. The effect however does not appear to be sustained in patients with anxiety and depression (Howard, 2005; Sempere et al., 2005).

Moreover, there is a significant potential for uncovering incidental findings in 6-15% patients, which may not necessarily require further management but can themselves increase anxiety (Katzman et al., 1999; Morris et al., 2009; Vernooij et al., 2007), and even potentially affect insurance coverage/premiums for that individual.

An information sheet can be useful to act as an ‘aide memoire’ when discussing these issues (link to information sheet about brain imaging).