Which statement about imaging in cluster headache is true?

Which statement about imaging in cluster headache is true?

• A. Imaging is never necessary.
• B. Imaging is not useful.
• C. Imaging is recommended at initial diagnosis to exclude brain and pituitary abnormalities.
• D. Only contrast-enhanced MRI is useful.

Answer: (C)

Imaging is used as a screening step at the first evaluation to rule out other causes that can mimic or accompany cluster headache, especially lesions in the brain or around the pituitary. An MRI of the brain with a pituitary-focused protocol is preferred because it detects tumors, pituitary lesions, aneurysms, and other structural problems that could change management or require treatment beyond headache therapies. Non-contrast MRI can identify many issues, and contrast may be added when pituitary pathology is a concern; CT is less sensitive for soft-tissue details but can be useful in specific urgent scenarios. This is why the statement about imaging at initial diagnosis to exclude brain and pituitary abnormalities is the best choice.

Imaging is used as a screening step at the first evaluation to rule out other causes that can mimic or accompany cluster headache, especially lesions in the brain or around the pituitary. An MRI of the brain with a pituitary-focused protocol is preferred because it detects tumors, pituitary lesions, aneurysms, and other structural problems that could change management or require treatment beyond headache therapies. Non-contrast MRI can identify many issues, and contrast may be added when pituitary pathology is a concern; CT is less sensitive for soft-tissue details but can be useful in specific urgent scenarios. This is why the statement about imaging at initial diagnosis to exclude brain and pituitary abnormalities is the best choice.