Choosing Wisely:

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

Rationale and Comments: Numerous evidence-based guidelines agree that the risk of intracranial disease is not elevated in migraine. However, not all severe headaches are migraine. To avoid missing patients with more serious headaches, a migraine diagnosis should be made after a careful clinical history and an examination that documents the absence of any neurologic findings such as papilledema. Diagnostic criteria for migraine are contained in the International Classification of Headache Disorders.
Sponsoring Organizations:
  • American Headache Society
  • Sources:
  • American Academy of Neurology guidelines
  • Disciplines:
  • Neurologic
  • References: • Frishberg BM. The utility of neuroimaging in the evaluation of headache in patients with normal neurologic examination. Neurology. 1994 Jul;44(7):1191-7.
    • Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000 Sep 26;55(6):754-62.
    • Neuroimaging for the evaluation of chronic headaches: an Evidence-based analysis. Ont Health Technol Assess Ser. 2010;10(26):1-57.
    • Headache Classification Subcommittee of the International Headache Society. International classification of headache disorders. Cephalalgia. 2004 Sep 1;4(1):1-151.

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