The American Headache Society (AHS) recently released a list of specific tests or procedures that are commonly performed but not always necessary in the treatment of migraines and headaches. The list was developed as part of Choosing Wisely, an initiative of the ABIM Foundation.
The AHS list identifies five targeted, evidence-based recommendations that can support conversations between patients and physicians about what care really is necessary. The list, which includes the following, also has been published in the November/December 2013 issue of Headache: The Journal of Head and Face Pain:
- Don’t perform neuroimaging studies in patients with stable headaches that meet criteria for a migraine.
- Don’t perform CT imaging for a headache when MRI is available, except in emergency settings.
- Don’t recommend surgical deactivation of migraine trigger points outside of a clinical trial.
- Don’t prescribe opioid- or butalbital-containing medications as first-line treatment for recurrent headache disorders.
- Don’t recommend prolonged or frequent use of over- the-counter pain medications for headache.The AHS Choosing Wisely list was developed after months of careful consideration and review, using the most current evidence about management and treatment options. The list was developed in consultation with AHS members, who received an electronic survey informing them of the project and asking them to recommend items to be considered for the list. The task force reviewed a list of 11 candidate topics that had been developed from the more than 100 suggestions received from AHS members. Final items were selected based on commonly encoun- tered situations in headache medicine associated with poor patient outcomes, low-value care, or misuse or over- use of resources. The AHS executive committee and board of directors then approved the list.— SOURCE: AMERICAN HEADACHE SOCIETY