American Headache Society: Five Tests, Treatments That 'Physicians and Patients Should Question' — Physician’s First Watch

Medical News |
November 22, 2013

American Headache Society: Five Tests, Treatments That 'Physicians and Patients Should Question'

By Amy Orciari Herman

The American Headache Society has released a list of five things in headache medicine that "physicians and patients should question." The list, published as part of the American Board of Internal Medicine's "Choosing Wisely" campaign, advises the following:

  • Don't perform neuroimaging on patients who have stable headaches that meet migraine criteria.

  • Don't perform computed tomography for headache when magnetic resonance imaging is available, except in emergency situations when hemorrhage, stroke, or head trauma is suspected.

  • Don't recommend surgical deactivation of migraine trigger points outside of clinical trials, as the value of this treatment remains undetermined.

  • Don't use opioids or butalbital-containing medications (e.g., Fioricet) as initial therapy for recurrent headache disorders.

  • Don't recommend prolonged use (more than 2 days/week) of over-the-counter pain medications for headache.

Reader Comments (3)

ashi sarin m.d Physician, Obstetrics/Gynecology, patiala India

these are very relevant as most patients of headache have unnecessary investigations

Jill Ell RN CNP Other Healthcare Professional, Psychiatry, Mental Health Clinic

When working with someone who is suffering a list of don't is not helpful. And I don't believe providers will stop doing this list of don't unless they are offered what else to do. I don't prescribe for this population but I work with there depression as a result of such pain.
People feel abandoned when all their provider can say is we can't do and offers no help. Other than wait 2 months until you can see a specialist

Ellen Grant, MBChB, DOsbstRCOG Physician, Neurology, Retired

I agree with the recommendations of the Headache Society. It is usually simple to prevent migraine if patients avoid common precipitants.1 There can be tenfold reduction in migraine attacks when patients stop taking contraceptive or menopausal hormones, smoking and ergot containing medications.2,3 Further exclusion and re- introduction dieting with avoidance of food allergies prevented most attacks minimizing the need for medication or exposure to diagnostic radiation in my patients over the past 40 years.4,5

1. Grant ECG. Relation between headaches from oral contraceptives and development of endometrial arterioles. BMJ 1968;3:402-5
2. Grant ECG, Albuquerque M, Steiner TJ, Rose FC. Oral contraceptives, smoking and ergotamine in migraine. In Current Concepts in Migraine Research. Ed. Greene R. Raven Press, New York 1978 pp97-100
3. Grant ECG. Oral contraceptives, smoking, migraine and food allergies. Lancet 1978;2:581-2
4. Grant ECG. Food allergies and migraine. Lancet 1979;1:966-69
5. Grant ECG. The pill, hormone replacement therapy, vascular and mood over-reactivity , and mineral imbalance .J Nutr Environ Med 1998;8:105-116.

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