What Type of Brain Imaging is Warranted for this Headache?

Recommendations from the American College of Radiology

Does My Headache Warrant an MRI?. Glo Wellness/Getty Images

When a patient has a dangerous headache, doctors will order imaging of the brain. This imaging will reveal whether there is a serious condition going on around the brain, like a bleed.

But what type of imaging will your doctor order? A CT scan or an MRI? Or a magnetic resonance angiography (MRA) of the brain, which is essentially an MRI of the brain's blood vessels.

The American College of Radiology has specific recommendations to help determine the optimal type of brain imaging needed for an acute headache.

These recommendations may help you better understand why your doctor is ordering one test over another.

Headache in a Person Who is Immunocompromised

Immunocompromised means that a person has an impaired immune system, weakening their ability to defend themselves against infection. Their impaired immune system could be secondary to a number of factors like disease (e.g. diabetes, HIV) or drugs (e.g. steroids, chemotherapy).

In this case, an MRI of the head with and without contrast media is recommended.

Headache in People Older than 60 with Suspected Giant Cell Arteritis

Giant cell arteritis is a type of vasculitis (inflammation of blood vessels) that typically causes a headache in the temple area and may be accompanied by a number of other symptoms including fatigue, jaw pain, and body aches. The most worrisome feature of GCA is vision loss.

In this case, an MRI of the head with and without contrast media is recommended.

Headache with Suspected Meningitis

Meningitis is an infection of the membranes that surround the brain and spinal cord. It is most commonly caused by a bacteria or virus, and rarely a fungus. Brain imaging is performed when a person with suspected meningitis is at a high risk for brain herniation—but ultimately a lumbar puncture is performed to make the diagnosis of meningitis.


In this case, an CT or MRI of the head without contrast media is recommended. 

Severe Headache in Pregnancy

While most headaches in pregnancy are benign, a doctor may order brain imaging if the headache is severe or associated with other worrisome symptoms like neurological symptoms. 

In this case, a CT or MRI of the head without contrast media is recommended. 

Severe, One-sided Headache Caused By Possible Arterial Dissection 

Dissection refers to tearing of the inside wall of the blood vessels that supply the brain. Dissection of the carotid and vertebral arteries usually causes pain of the head and/or neck and is a life-threatening condition, as it can lead to stroke.

In this case, MRI of the head with and without contrast media, MRA of the head and neck, or CTA of the head and neck is recommended.

Sudden Onset or Severe Headache

A headache that is severe and/or begins suddenly is particularly worrisome for a bleed in the brain (i.e. subarachnoid hemorrhage) and warrants emergent brain imaging.

In this case, a CT of the head without contrast media, CTA of the head with contrast media, MRA of the head with or without contrast media, or MRI of the head without contrast media is recommended.

A Word from Verywell

If you see your doctor or go to the emergency room with a potentially dangerous headache, imaging of the brain will be ordered. While you do not necessarily need to know what to order—that's why we have doctors—it's reassuring to know there are recommendations your doctor is following. 


Gonzalez-Gay MA, Barros S, Lopez-Diaz MJ, Garcia-Porrua C, Sanchez-Andrade A, Llorca J. Giant cell arteritis: disease patterns of clinical presentation in a series of 240 patients. Medicine (Baltimore). 2005 Sep;84(5):269-76.

Hainer BL & Matheson EM. Approach to Acute Headache in Adults. Am Fam Physician. 2013 May 15;87(10):682-87.

Silbert PL, Mokri B, Schievink WI. Headache and neck pain in spontaneous internal carotid and vertebral artery dissections. Neurology. 1995 Aug;45(8):1517-22.

Strain JD, et al. Headache. American College of Radiology. ACR appropriateness criteria. Radiology. 2000;215(suppl):855–860.

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