Cefalea… ¿y algo más? Neuroimágenes en el estudio de la cefalea

Abstract

A review is presented of the radiological findings (computed tomography –CT– and magnetic resonance imaging –MRI–) of headache, according to our experience. According to MESH database this entity is a skull based pain that can have a benign cause or be an expression of a wide spectrum of disorders.Headaches can be classified according to their temporal evolution (acute or chronic), presentation (blow up, aura, rapidly evolutionary, etc.), or according to associated symptoms, such as seizures or focal deficits. They could also be classified into primary or secondary, depending on the presence or absence of demonstrable disease. The primary headaches can have known symptoms (i.e. migraine), but in secondary ones certain symptoms and signs should alert on the existence of structural disease. At this point imaging methods have an outstanding role, as they allow detecting and identifying structural causes in patients with headache.Our findings corresponded to primary headaches (i.e.: migraine infarction) and organic aetiologies, such as vascular causes (venous thrombosis, vasospasm and posterior reversible leukoencephalopathy); intracerebral and extra-axial haemorrhage; post-surgical and post- traumatic headaches; and those due to infections and tumours (pituitary apoplexy or intracranial hypertension). Malformations, such as Arnold-Chiari's, and intracranial hypotension have also been found.In some cases a CT is initially performed and then an MR, whilst in others MR is the method of choice.Neuroimaging facilitates the study of headache, helping to characterise them into primary or secondary. In the latter case, the imaging also enables the findings to be classified.