What imaging modality does the American College of Radiology recommend for sudden onset, severe headaches?

• A. CT without IV contrast
• B. MRI with contrast
• C. Plain X-ray of the head
• D. Ultrasound of the neck

Answer: (A)

The recommendation from the American College of Radiology for sudden onset, severe headaches is to use a CT scan without IV contrast. This imaging modality is particularly effective in quickly ruling out potentially life-threatening conditions such as intracranial hemorrhages or an acute stroke, which are critical considerations in patients presenting with a sudden and severe headache. The speed and accessibility of a CT scan make it an ideal first-line diagnostic tool in the emergency setting.

CT scans can provide immediate results, allowing clinicians to make timely decisions regarding the management of the patient's condition. In contrast, other imaging modalities like MRI with contrast are generally not preferred in acute situations due to longer acquisition times and may not be readily available in all emergency settings. Plain X-rays of the head have limited utility in evaluating intracranial pathology and would not provide sufficient information regarding acute headache etiologies. Ultrasound of the neck, while useful for assessing vascular issues, does not directly evaluate intracranial structures and would not suffice for evaluating the causes of sudden severe headaches. Thus, the CT scan without IV contrast is the best choice for prompt evaluation and diagnosis.