Headache docs list top 5 tests and treatments to avoid

Young woman, hand on forehead, eyes closed, close-up depressed headache.
Young woman, in obvious pain with a headache. David Sutherland

Doctors who specialize in treating head pain, such as chronic migraines, are out with a list of five procedures and treatments they think have risks or costs that may outweigh the benefits.

The American Headache Society's list is part of the American Board of Internal Medicine's Choosing Wisely campaign that has seen cancer doctors, eye doctors and chest surgeons naming the overused or unproven practices their peers should avoid and patients should question.

The newest Choosing Wisely list was published Thursday in the journal Headache.

"The article and recommendations identify situations that are felt by experts to be cases where patients and doctors should think very carefully before they decide to use that particular treatment or intervention," said Dr. Elizabeth Loder, an author of the new recommendations.

Loder is the president of the American Headache Society, and chief of the Division of Headache and Pain at Brigham and Women's Hospital in Boston.

All tests and treatments have risks, Loder said. For example, imaging techniques such as CT scans expose patients to potentially cancer-causing radiation, and certain pain medications sometimes used to treat headaches are easy to get hooked on.

The list of five:

1- Don't perform neuroimaging studies in patients with stable headaches that meet criteria for migraine;

2- Don't perform computed tomography imaging for headache when magnetic resonance imaging is available, except in emergency settings;

3- Don't recommend surgical deactivation of migraine trigger points outside of a clinical trial;

4- Don't prescribe opioids like oxycodone and drugs containing butalbita like Fioricet – for patients who get headaches often;

5- Don't recommend prolonged or frequent use of over-the-counter pain medications for headache.

The goal of the recommendations is to encourage discussion between patients and their doctors about which tests are overall beneficial to patients, she said.

"The purpose is to start a conversation about situations, tests, procedures and interventions that do not necessarily benefit the patient, and sometimes can even cause problems," Loder said.

To come up with the recommendations, Loder and her coauthors asked physician members of the American Headache Society (AHS) to identify tests and treatments they view as being used incorrectly or too often, and which methods of care had benefits too small to outweigh the risks.

The researchers evaluated more than 100 items suggested by AHS members.

The recommendations, Loder added, "are a nice distillation for patients when thinking about their care." Patients and their families can use the guidelines to start a conversation with their doctor about the pros and cons of a given test or procedure.

"In addition to thinking about the good things that may come about from interventions, it's also important to think about situations in which caution can be used," Loder told Reuters Health.