Table 2:

From the American College of Radiology Appropriateness Criteria—Headache Clinical Variants (revised, 2019)

Variant 1: Sudden, severe headache or “worst headache of life.” Initial imaging.

Variant 2: New headache with optic disc edema. Initial imaging.

Variant 3: New or progressively worsening headache with one or more of the following “red flags”: subacute head trauma, related activity or event (sexual activity, exertion, position), neurologic deficit, known or suspected cancer, immunosuppressed or immunocompromised state, currently pregnant, or 50 years of age or older. Initial imaging.

Variant 4: New headache. Classic migraine or tension-type primary headache. Normal neurologic examination findings. Initial imaging.

Variant 5: New primary headache of suspected trigeminal autonomic origin. Initial imaging.

Variant 6: Chronic headache. No new features. No neurologic deficit. Initial imaging.

Variant 7: Chronic headache. New features or increasing frequency. Initial imaging.