Choosing Wisely - Tests for headaches

Imaging tests rarely help

Doctors see many patients for headaches and most of them have migraines or headaches caused by tension. Both kinds of headaches can be very painful, but a CT scan or an MRI rarely shows why the headache occurs. Having a CT scan or MRI also does not help ease the pain.

A doctor can diagnose most headaches during an office visit. The doctor asks you questions about your health and your symptoms. This is called a medical history. Then the doctor may do what is called a neurological exam, which includes a test of your reflexes. If your medical history and exam are normal, usually imaging tests will not show a serious problem.

Imaging tests have risks

A CT scan of the head uses a low radiation dose. This may slightly increase the risk of harmful effects such as cancer. Risks from radiation exposure may add up, so it is best to avoid unnecessary radiation.

The results of your CT scan or an MRI may also be unclear. This can lead to more tests and even treatment that you do not need.

When should you have an imaging test for headaches?

In some cases you might need a CT scan or an MRI. You might need one if your doctor cannot diagnose your headache based on your neurological exam and medical history. Or you might need one if the exam finds something that is not normal.

You may also need a CT scan or an MRI if you have unusual headaches. See your doctor right away if:

• You suddenly develop a very severe headache which feels like something is bursting inside your head.
• Your headaches are different from other headaches you’ve had, especially if you are age 50 or older.
• Your headaches happen after you have been physically active.
• You have headaches with other serious symptoms, such as a loss of control, a seizure or fit, or a change in speech or alertness.

How to treat a headache

Your doctor can advise you on how best to treat your headache. You can help most headaches by taking these steps:

Avoid triggers. Triggers are events that can cause headaches. These tips can help you avoid triggers: If you have migraines:

• Wear tinted glasses in bright light.
• Do not skip meals.
• Avoid alcohol, meat with added nitrates (such as cold cuts), and aged cheeses (hard, dry cheeses such as parmesan).

If you have tension headaches:

• Avoid getting over tired.
• Hold your back and neck straight when you sit or stand.
• Keep your jaw relaxed (not clenched).

Quit smoking. Smoking can bring on either kind of headache.

Manage stress. Try meditation, yoga, stretching, or other activities that can help you relax.

Get plenty of sleep. Aim for six to eight hours of sleep each night. Set a regular time to go to bed and to wake up. Avoid watching TV or using a computer just before you go to bed.

Get plenty of exercise. Regular exercise, such as swimming, brisk walking, or cycling, can reduce stress and ease both kinds of headaches.

Non-prescription pain medicines such as the following can help:

• paracetamol.
• ibuprofen.
• naproxen. You can buy all of these without a prescription. Try not to take any of these pills more than once or twice a week. Overuse can make headaches worse and cause side effects.

If your headaches are severe or happen often, there are medications which your doctor can prescribe to help lower the pain level and/or reduce how frequently you get them.

It’s OK to ask questions
If you have questions about your symptoms or the medicines managing your symptoms, speak with your health professional.

You can also download this information as a pdf (397 KB).

© 2016 Consumers Union of United States, Inc, (101 Truman Ave, Yonkers, NY 10703-1057). Adapted from Consumer Reports (2016) and Choosing Wisely Canada (2014), Imaging tests for headaches, developed in cooperation with the Canadian Association of Radiologists. Choosing Wisely does not assume any responsibility or liability arising from any error or omission or from the use of any information in these resources.