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When does a headache need further tests like a brain scan? A team of experts reviewing the evidence has come up with some guidelines. When is a headache worth a brain scan? Unnecessary brain imaging is thought to cost the system a fortune. This is despite doctors knowing that almost everyone gets a headache sometime and that almost all of them are benign. Some believe the focus on rare conditions also means that treatable headaches like migraine are underdiagnosed. A review of the worldwide evidence on headache diagnosis has attempted to simplify the symptoms to look for. The clearest were for migraine. The word to remember is POUNDING. The P is for pulsating headaches which last between 4 and 72 hours (hours where they get the O from); the U in pounding is for unilateral, meaning one-sided, the N is nausea and the D is disabling. If you score all four then the chances are high you have migraine. The review was less precise on the worrying signs. A sudden severe headache is ominous as are any neurological abnormalities. Another message is that if you're having headaches you've never had before and the doctor can't fit them into a recognisable pattern then you probably need further tests.
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