Rosh Internal Medicine Boost Practice Exam

What is the most appropriate strategy for a healthy man with episodic tension-type headaches and a normal neurological examination?

1. CT scan

2. MRI with contrast

3. MRI without contrast

4. No diagnostic study is necessary

The correct answer is: No diagnostic study is necessary

In the case of a healthy man experiencing episodic tension-type headaches and having undergone a normal neurological examination, the most appropriate strategy is to forgo any diagnostic imaging studies. Tension-type headaches are characterized by a pressing or tightening sensation, often described as mild to moderate in intensity. They are not typically associated with significant neurological deficits or alarming symptoms that would warrant additional imaging, especially in the absence of red flags such as changes in headache pattern, neurological symptoms, or systemic signs of illness. A normal neurological examination further supports the likelihood that these headaches are primary rather than secondary to another underlying condition that might necessitate imaging. Diagnostic imaging, such as CT or MRI, is generally reserved for cases where there are concerning features that suggest a serious underlying cause, like tumors, vascular malformations, or other intracranial pathology. In this scenario, the overall assessment indicates that the headaches are benign and that further diagnostic evaluation would not provide additional value. This aligns with clinical guidelines that recommend observation and symptomatic management for patients with typical tension-type headaches and normal neurological findings.