July 27, 2021

I have been suffering from headaches for many years, is it appropriate to do an MRI?


S.I have been suffering from headaches for many years (now I am fifty) and after taking it lightly for so long now, perhaps because I find myself with so much time to think, I start to get seriously worried even though the episodes, such as intensity, duration and frequency have remained more or less unchanged over time. When the headache has lasted for many years, in your opinion it is advisable to undergo an MRI of the brain – or other tests – in order to rule out the worst fears: brain cancer, pharyngioma, and a whole series of diseases that only to name them terrify me?

Maria Clara Tonini, Head of Headache Diagnosis and Treatment Center, Clinica S. Carlo P. Dugnano, Milan, answers.

Headache, in most cases, a benign condition and should not worry to the point of having to think about undergoing a CT scan of the brain or an MRI, with or without contrast, and not even urgent blood tests, such as an ESR or a C reactive Protein, or a neurological evaluation with an urgent character.

Clinical indicators

We have a series of indicators that allow us to identify a potentially dangerous or secondary form of headache (attributable to an underlying disease). I try to list them: new headache, unexpected or with new characteristics; change in a pre-existing headache (increase in duration, frequency and intensity of the headache); onset of the worst headache of one’s life; sudden, explosive onset of headache; subacute course of headache which however worsens over several days or weeks; presence of fever; neurological symptoms such as confusion, impaired consciousness, visual disturbance, difficulty swallowing, speaking or understanding others; loss of strength or sensation or simply tingling in one limb (upper or lower) or both, disturbance of balance or uncertainty with walking or coordination.

Worsening

If the headache has been known for a long time and has taken a pejorative course due to a chronic evolution (i.e. a headache present for more than 15 days a month for more than 3 months), which, by reading the letter you sent us , it seems to be possible to exclude, we need to investigate the situation by evaluating some parameters. Also in this case I try to list them: presence, monitored through a diary, of more than 5-10 days of headache per month, which can lead to the excessive use of analgesics (non-steroidal anti-inflammatory drugs – NSAIDs -; paracetamol; triptans; combination (containing more active ingredients in particular caffeine); opioids; presence of unrecognized arterial hypertension; sleep disturbances; snoring; depression. These could be precisely the reasons that lead to worsening and that must be excluded before thinking about others, well more serious, to which he refers in his letter.

Headache Center

Of course, it is always good to consult your doctor or go to a clinic or a headache center, to have an anamnestic and neurological reassessment and move on to a therapeutic strategy appropriate to the case or possibly to targeted diagnostic tests.

November 9, 2020 (change November 9, 2020 | 21:44)

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