Fast Five Quiz: How Much Do You Know About Migraines?

Amy Kao, MD; Sumaira Nabi, MBBS; Jasvinder Chawla, MD, MBA


October 19, 2017

The American Headache Society released a list of five commonly performed tests or procedures that are not always necessary in the treatment of migraine and headache, as part of the American Board of Internal Medicine (ABIM) Foundation's Choosing Wisely campaign. The recommendations include the following:

  • Don't perform neuroimaging studies in patients with stable headaches that meet criteria for migraine.

  • Don't perform CT for 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.

Neuroimaging is unnecessary in patients with a history of recurrent migraine headaches and a normal neurologic examination. Neuroimaging is indicated for any of the following:

  • First or worst severe headache

  • Change in the pattern of previous migraine

  • Abnormal neurologic examination

  • Onset of migraine after age 50 years

  • New onset of headache in an immunocompromised patient (eg, one with cancer or HIV infection)

  • Headache with fever

  • Migraine and epilepsy

  • New daily, persistent headache

  • Escalation of headache frequency/intensity in the absence of medication overuse headache

  • Posteriorly located headaches (especially in children, but also in adults)

For more on the work-up of migraine, read here.


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