This topic continues to lead to a growing number of reports/recommendations. Of the 8 or so abstracts I have, we now have a 100% agreement that imaging should be done for all new cases.
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Curr Opin Neurol. 2009 Jun;22(3):247-53.
Neuroimaging in trigeminal autonomic cephalgias: when, how, and of what?

Wilbrink LA, Ferrari MD, Kruit MC, Haan J.

Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.

PURPOSE OF REVIEW: Trigeminal autonomic cephalgias (TACs) are characterized by frequent, short-lasting headache attacks with ipsilateral facial autonomic features. They include CLUSTER HEADACHE, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. The pathogenesis of TACs is largely unknown, but many case reports in the literature suggest that TACs are secondary to structural lesions. Thus, the question arises whether TAC patients should undergo neuroimaging. Here, we review the recent literature on secondary TACs and attempt to formulate guidelines for neuroimaging. RECENT FINDINGS: Recently, we published two reviews of, in total, 33 case reports of patients with a secondary TAC or TAC-like syndrome. Since then, 23 additional cases have been published. Here, we provide a summary of these 56 case reports. TACs were found to be associated with a wide range of both intracranial and extracranial neurovascular and structural lesions. We could not identify a 'typical' clinical warning profile for secondary TACs as these patients could present with clinical features that are entirely characteristic of a TAC, including alternating attack and attack-free periods, and excellent response to TAC-specific treatments. SUMMARY: EVEN CLINICALLY TYPICAL TACS CAN BE CAUSED BY STRUCTURAL LESIONS. THERE ARE NO 'TYPICAL' WARNING SIGNS OR SYMPTOMS. NEUROIMAGING SHOULD BE CONSIDERED IN ALL PATIENTS WITH TAC OR TAC-LIKE SYNDROMES, NOTABLY IN THOSE WITH ATYPICAL PRESENTATION. DEPENDING ON THE DEGREE OF SUSPICION, ADDITIONAL IMAGING SHOULD BE CONSIDERED ASSESSING INTRACRANIAL AND CERVICAL VASCULATURE, AND THE SELLAR AND PARANASAL REGION.

Publication Types:
Research Support, Non-U.S. Gov't
Review

PMID: 19434790 [PubMed]

Marc wrote on Jul 14^th, 2009 at 11:46am:

Marc - Lack of grey matter does not constitute "coming out clean."

Brew wrote on Jul 14^th, 2009 at 1:18pm:


Actually I think it does qualify as squeaky clean!

In fact, the way our Government is going, I think that there is a lot brain washing going on.................

Marc wrote on Jul 14^th, 2009 at 2:45pm:

The neuro and HA Specialist sent me in for MRIs so the Gov't could Brainwash ME???   hmmm   a bit suspect... I think no differently.  Actually I think as little as possible these days... it hurts to think 

There are some really great "TFH" pictures around from the original days here at ch.com (Paco's comes to mind) but I will say that:

The RIGHT way to deal with a new Clusterhead potential diagnosis is to get the imaging done - the whole point of Bob's original post.

Even if you have all of the classic symptoms, get it confirmed by ruling out the stuff that can kill you.

Marc

I think they can give you enough valium so that you don't remember or care that you're claustrophobic.