There are many causes of headaches. A distinction is made between primary headaches, i.e. those without an underlying illness, and secondary headaches as a result of an illness. With the help of MRI (magnetic resonance imaging), and in some cases, alternatively, computer tomography (CT), many causes of headaches can be detected directly. In the following table, these are marked with “MRI!” or “CT!” if the MRI or CT is essential for the diagnosis. Imaging with MRI and/or CT also provides valuable information in many other cases; these are marked with “MRI” or “CT”. Only if the cause is found can targeted therapy be carried out and provide effective relief. And avoid overlooking dangerous causes – however rare they may be!
Our recommendation
A CT scan of the head is ideal for the rapid assessment of acute injuries and bleeding, while MRI provides detailed images of soft tissue and brain structures.
Primary, idiopathic headache without underlying disease:
- Tension headache – MRI
- Migraine
- Cluster headache
- Mixed and other, rarer primary forms
Secondary headaches:
- Injuries to the head and/or cervical spine – MRI/CT!
- Vascular disorders in the head or neck area such as stroke and cerebral venous thrombosis – MRI/CT!
- Brain tumors – MRI!
- Condition after lumbar puncture with cerebrospinal fluid leak – MRI!
- Drug-induced headache
- Intoxicants and stimulants: cocaine, alcohol, cannabis
- Headache as an adverse effect of medication, e.g. nitrates, phosphodiesterase-5 inhibitors, calcium channel blockers, oral contraceptives (hormonal contraception)
- After withdrawal from a substance, e.g. caffeine withdrawal headache, opioid withdrawal headache, estrogen withdrawal headache
- Food-induced headache, such as histamine headache, see Histamine intolerance
- Infectious diseases such as meningitis, encephalitis, brain abscess – MRI!
- Oxygen deficiency – MRI
- Altitude sickness – MRI
- High blood pressure – MRI!
- Hypothyroidism
- Sunstroke
- Diseases of the skull, neck, eyes, ears, nose, sinuses, teeth, mouth, etc., e.g. sinusitis, changes in the temporomandibular joint, dental problems, etc. – MRI/CT!
- Psychosomatic and psychiatric disorders
