BACKGROUND: Headache is one of the most common complaints that lead the patient to seek medical advice however only a few patients with recurrent headaches have a secondary cause like intracranial mass. The appropriate utilization of neuroimaging is important to rule-out secondary cause of headache in resource-limited regions. The objective of this study is to describe the patterns of MRI findings in the evaluation of patients with chronic headache and to determine the clinical variables helpful in identifying patients with intracranial lesions.MATERIALS AND METHODS: This cross sectional study was conducted among 590 selected patients who underwent an MRI scan of the head from September 2016 to January 2018 at Wudassie Diagnostic center in Addis Ababa, Ethiopia. Siemens Magnetom 0.35T MRI was used.RESULTS: Out of 590 patients, 372 (63.1%) were females and 218 (36.9%) were males; 300 (50.8%) patients with the mean age of 38.6 + 0.5 years and a median of 37 + 16.7years have normal brain MRI and 290(49.2%) have abnormal brain MRI reports. The abnormal findings further divided into non-significant findings were 166(28%) that did not alter patient management and clinically significant findings were 124 (21%) which included by decreasing order of frequency tumors, infection, hydrocephalus, hemorrhage, and vascular abnormalities.CONCLUSION: It was 1.3 times higher rate of positive brain MR findings in patients who had headaches plus abnormal neurologic findings as compared to patients without neurologic abnormality (P-value = 0.01).  There is a high rate of significant abnormal MRI findings in this study as compared to studies from developed nations.KEYWORDS: Chronic headache, Neuroimaging, MRI, CT-scan, Ethiopia, Africa