Migraine Don'ts in Treatment and Testing

In this case, it's not so much "Don't" as it is "hesitate". Think of these things not so much as stop lights as amber warning lights.

This list was created through the American Headache Society in cooperation with the American Board of Internal Medicine Foundation in their "Choose Wisely" campaign. The idea is to highlight key things that patients and even health workers should question when it comes to migraine.

I'll list them here with my own comments, but you can find more information at the link below.

Don’t perform neuroimaging studies in patients with stable headaches that meet criteria for migraine. -- In other words, yes - carefully diagnose your patient, and watch carefully for emergency warning signs (such as papilledema, the swelling of the optic disc). But in most cases, neuroimaging will be of no help.
Don’t perform computed tomography (CT) imaging for headache when magnetic resonance imaging (MRI) is available, except in emergency settings. -- If scanning is deemed necessary to rule out other conditions, usually that means MRI, unless there is specific reason to use CT, such as suspected stroke. MRI not only avoids the radiation concerns of CT, it also does a better job in many ways.
Don’t recommend surgical deactivation of migraine trigger points outside of a clinical trial. -- Basically, the authors of the list feel there is still not enough evidence to prefer migraine surgery over the many many non-surgical treatments that are available.
Don’t prescribe opioid or butalbital-containing medications as first-line treatment for recurrent headache disorders. -- Yes, there still is an open door to use these medications in some cases. But there are so many excellent other options available today, the risks can be avoided for most patients.
Don’t recommend prolonged or frequent use of over-the-counter (OTC) pain medications for headache. -- This is one that's hard to summarize. There are a number of reasons why OTC medications are not necessarily the best for migraine, especially if you're experiencing migraine every few weeks or more. Consider other options.

This last one is something that many patients and even doctors don't understand. If you're relying on over the conter medications such as Tylonol or Advil, and you haven't seen an experienced migraine specialist, you could be looking at long term problems/pain in exchange for some short term relief.

Again, these are not hard-and-fast rules for everyone in every situation. Talk to a doctor who knows your medical history, and do your own research alongside that consultation. But, as the flyer points our, do question.

For more information, check out Five Things Physicians and Patients Should Question (pdf).

A few posts from the past...

Here is some more related information that you may find useful:

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