Choosing Wisely:

Don’t do imaging for uncomplicated headache.

Rationale and Comments: Imaging headache patients absent specific risk factors for structural disease is not likely to change management or improve outcome. Those patients with a significant likelihood of structural disease requiring immediate attention are detected by clinical screens that have been validated in many settings. Many studies and clinical practice guidelines concur. Also, incidental findings lead to additional medical procedures and expense that do not improve patient well-being.
Sponsoring Organizations:
  • American College of Radiology
  • Sources:
  • American College of Radiology guidelines
  • American Academy of Neurology guidelines
  • Disciplines:
  • Neurologic
  • References: • Jordan JE, et al. ACR Appropriateness Criteria: headache. Reston, Va.: American College of Radiology; 2009.
    • Institute for Clinical Systems Improvement. Diagnosis and treatment of headache. Bloomington, Minn.: Institute for Clinical Systems Improvement; 2011.
    • Frishberg BM, et al. Evidence-based guidelines in the primary care setting: neuroimaging in patients with nonacute headache. American Academy of Neurology. 2000. professionals/practice/pdfs/gl0088.pdf.
    • Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache. Neurology. 2000;55:754.
    • Edlow JA, et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med. 2008;52(4): 407-36.

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