Background: There is a lack of research done on imaging findings of acute headache inrnEthiopia. Most studies available for cross-reference are done in developed countries and do notrntake into consideration clinical and epidemiologic factors unique to developing countries. rnObjective: To determine the most frequent imaging findings in patients presenting with acuternheadache and understand the association with sociodemographic and clinical factors in Ethiopia. rnMethodology: A retrospective cross-sectional analysis was adopted in this study. The brain MRIrnreports and files of 497 patients who were referred for the evaluation of acute headache (less thanrnor equal to one month duration) to Wudassie Diagnostic Center in Addis Ababa, Ethiopia fromrnJanuary 2016 to September 2018 were analyzed. The demographic variables and the clinical datarnof the patients were correlated to the imaging findings. Data analysis was done using IBM SPSSrnStatistics for Windows, Version 20.0. rnResults: An analysis of the neurological signs and symptoms showed 38.8% of the patientsrnreferred for the evaluation of acute headache had a neurological deficit. 60% of the patients hadrnabnormal MRI findings. Non-specific white matter lesions,(which neither explain the reason forrnacute headache nor alter patient outcome and management) was the most frequently observedrnradiologic diagnosis (16%) followed by neoplasms (11%) and infections (8%). Tuberculoma wasrnthe most frequently diagnosed infectious cause. The majority of patients with Comorbid illnessesrn(hypertension and HIV) had abnormal imaging findings. Age had a weak but significant positiverncorrelation with abnormal imaging findings. rnConclusions: The majority of patients who presented with acute headache had normal or minorrnMRI findings. The most frequent clinically significant brain MRI findings were neoplasms andrninfections. Older age is associated with an increased rate of abnormal imaging findings. Thernmost common infectious cause of acute headache is found to be Tuberculoma. rnRecommendations: A more detailed clinical history and physical examination should bernimplemented to properly identify patients who are candidates for neuroimaging. Future largernscale studies should be done on the imaging of acute headache in Ethiopia.