Headache Treatment: 5 Practices to Avoid

To help improve patient care, The American Headache Society (AHS) recently released five practices that health care professionals and patients should avoid or question regarding headache treatment. The guidelines and considerable information about them appeared in the November-December issue of Headache.

The list was created as part of the Choosing Wisely initiative of the American Board of Internal Medicine Foundation, which stresses the importance of physician and patient conversations in improving care and eliminating unnecessary tests and procedures. The Choosing Wiselyrecommendations should not be the final word in decisions about treating headache disorders or any other condition, experts say.  Instead, they are intended to foster conversation about what is — and is not — appropriate and necessary treatment.

The AHS recommendations for headache treatment are as follows:

  1. Don’t perform neuroimaging studies in patients with stable headaches that meet criteria for migraine.
  2. Don’t perform computed tomography (CT) scans for headache when magnetic resonance imaging (MRI) is available  — except in emergency situations.
  3. Don’t recommend surgical deactivation of migraine trigger points outside of a clinical trial.
  4. Don’t prescribe opioid or butalbital-containing medications as the first-line treatment for headache disorders.
  5. Don’t recommend prolonged or frequent use of over-the-counter (OTC) pain medications for headache.

To create these guidelines, the AHS board of directors created a Choosing Wisely task force, which developed the list in consultation with AHS members,who provided more than 100 suggestions for potential inclusion. The task force then selected final items that are common in headache treatment but are associated with poor patient outcomes, low-value care or misuse or overuse of resources.

The authors, led by Elizabeth Loder, MD, chief of the division of headache and pain in the neurology department at Brigham and Women’s Hospital in Boston, suggest healthcare professionals reference this list when they provide treatment. “We recommend that headache medicine specialists and other physicians who evaluate and treat headache disorders should use this list when discussing care with patients,” they wrote.

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