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Headache Society Lists Top Five Tests and Treatments to Avoid

Risks and costs may outweigh benefits (November 21)

The American Headache Society (AHS) is the latest group of experts to list procedures and treatments that they believe have risks or costs that may outweigh the benefits to patients.

As part of the Choosing Wisely initiative, the AHS surveyed its members to develop a candidate list of items for a “Top 5” list of low-value care in headache medicine. Through a process of literature review and consensus, a final list of five items was compiled.

The five recommendations approved by the AHS Board of Directors are:

  • Don’t perform neuroimaging studies in patients with stable headaches that meet criteria for migraine.
  • Don’t perform computed tomography imaging for headache when magnetic resonance imaging 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 a first-line treatment for recurrent headache disorders.
  • Don’t recommend prolonged or frequent use of over-the-counter pain medications for headache.

The recommendations were published in the journal Headache.

Source: Headache; November 21, 2013.

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