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.|
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• 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.