here is the latest of the choosing wisely suggestions (these are 5 suggestions by different specialties, with an eye to decrease unnecessary testing). see URL http://www.choosingwisely.org/wp-content/uploads/2013/11/AHS-5things-List_112013.pdf.
1.Don’t perform neuroimaging studies in patients with stable headaches that meet criteria for migraine. (no increase in intracranial disease in pts with migraine)
2.Don’t perform computed tomography (CT) imaging for headache when magnetic resonance imaging (MRI) is available, except in emergency settings (MRI more sens in picking up neoplasms, vasc dz, posterior fossa and cervicomedullary lesions, and high or low intracranial pressure disorders. and less radiation to boot…
3.Don’t recommend surgical deactivation of migraine trigger points outside of a clinical trial.
4.Don’t prescribe opioid or butalbital-containing medications as first-line treatment for recurrent headache disorders. they suggest that these meds increase likelihood that the headache disorder will become chronic, increase sensitivity to pain.
5.Don’t recommend prolonged or frequent use of over-the-counter (OTC) pain medications for headache. issue is causing medication overuse headaches
geoff