The American Headache Society (AHS) today released a list of specific tests or procedures that are commonly performed but not always necessary in the treatment or migraine and headache. The list was developed as part of Choosing Wisely®, an initiative of the ABIM Foundation. It identifies five targeted, evidence-based recommendations that can support conversations between patients and physicians about what care is really necessary. The list is being released simultaneous with its publication in the November-December, 2013 issue of the journal Headache.
AHS's list identified the following five recommendations:
• Don't perform neuroimaging studies in patients with stable headaches that meet criteria for migraine
• Don't perform computed tomography (CT) imaging for headache when magnetic resonance imaging (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 (OTC) pain medications for headache
"All of us on the front lines of medicine know we have the opportunity to improve the care we deliver by engaging our patients in conversations about what care is really necessary and beneficial to their health. The recommendations in migraine and headache treatment released today provide valuable information to help patients and physicians start important conversations about treatment options and make wise choices," said Elizabeth Loder, MD, MPH, President of the American Headache Society. Dr. Loder is Chief of the Division of Headache and Pain in the Department of Neurology at the Brigham and Women's Hospital in Boston.
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 AHS Board of Directors approved the creation of a task force to lead work on the Choosing Wisely® campaign. The task force consisted of Dr. Loder; Stephen Silberstein, MD, (Chair of the AHS Guidelines and Position Paper Committee); Randolph Evans, MD; Benjamin Frishberg, MD; Scott Litin, MD; Donald Dworek, MD; Josif Stakic, MD; and Jessica Ailani, MD. 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 over 100 suggestions received from AHS members. Final items were selected based on commonly encountered situations in headache medicine associated with poor patient outcomes, low-value care or misuse or overuse of resources. The five recommendations were then approved by the AHS Executive Committee and Board of Directors.
"AHS has shown tremendous leadership by releasing its list of tests and procedures they say are commonly done in migraine and headache treatment, but aren't always necessary," said Richard J. Baron, MD, president and CEO of the ABIM Foundation. "The content of this list and all of the others developed through this effort are helping physicians and patients across the country engage in conversations about what care they need, and what we can do to reduce waste and overuse in our health care system."
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