Fast Five Quiz: Test Your Clinical Knowledge of Various Types of Headaches

Amy Kao, MD


November 27, 2018

Measurement of erythrocyte sedimentation rate and C-reactive protein may be appropriate to rule out temporal/giant cell arteritis. Visual field testing should be performed in patients with persistent visual phenomena.

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 Foundation's Choosing Wisely campaign. The recommendations include the following:

  • Do not perform neuroimaging studies in patients with stable headaches that meet criteria for migraine.

  • Do not perform CT for headache when MRI is available, except in emergency settings.

  • Do not recommend surgical deactivation of migraine trigger points outside of a clinical trial.

  • Do not prescribe opioid or butalbital-containing medications as first-line treatment for recurrent headache disorders.

  • Do not recommend prolonged or frequent use of over-the-counter pain medications for headache.

CT without intravenous contrast also may miss some aneurysms. MRI and MRA are more sensitive for the detection of aneurysm or arteriovenous malformation.

For more on the workup of migraine, read here.


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