American Headache Society Releases List ofCommonly Used Tests and Treatments to Question

Choosing Wisely® campaign aims to encourage physician and patient conversations by identifying five tests or procedures to question, highlighting potentially unnecessary—sometimes harmful—care in migraine and headache treatment

Released: 5-Nov-2013 2:00 PM EST
Embargo expired: 21-Nov-2013 12:05 AM EST
Source Newsroom: American Headache Society (AHS)
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Citations Headache, November-December, 2013

Newswise — The American Headache Society (AHS) today released a list of specific tests or procedures that are commonly performed but not always necessary in the treatment or migraine and headache. The list was developed as part of Choosing Wisely®, an initiative of the ABIM Foundation. It identifies five targeted, evidence-based recommendations that can support conversations between patients and physicians about what care is really necessary. The list is being released simultaneous with its publication in the November-December, 2013 issue of the journal Headache.

AHS’s list identified the following five recommendations:
• Don’t perform neuroimaging studies in patients with stable headaches that meet criteria for migraine
• Don’t perform computed tomography (CT) imaging for headache when magnetic resonance imaging (MRI) is available, except in emergency settings
• Don’t recommend surgical deactivation of migraine trigger points outside of a clinical trial
• Don’t prescribe opioid or butalbital-containing medications as first-line treatment for recurrent headache disorders
• Don’t recommend prolonged or frequent use of over-the-counter (OTC) pain medications for headache

“All of us on the front lines of medicine know we have the opportunity to improve the care we deliver by engaging our patients in conversations about what care is really necessary and beneficial to their health. The recommendations in migraine and headache treatment released today provide valuable information to help patients and physicians start important conversations about treatment options and make wise choices,” said Elizabeth Loder, MD, MPH, President of the American Headache Society. Dr. Loder is Chief of the Division of Headache and Pain in the Department of Neurology at the Brigham and Women’s Hospital in Boston.

The AHS Choosing Wisely list was developed after months of careful consideration and review, using the most current evidence about management and treatment options. The AHS Board of Directors approved the creation of a task force to lead work on the Choosing Wisely® campaign. The task force consisted of Dr. Loder; Stephen Silberstein, MD, (Chair of the AHS Guidelines and Position Paper Committee); Randolph Evans, MD; Benjamin Frishberg, MD; Scott Litin, MD; Donald Dworek, MD; Josif Stakic, MD; and Jessica Ailani, MD. The list was developed in consultation with AHS members, who received an electronic survey informing them of the project and asking them to recommend items to be considered for the list. The task force reviewed a list of 11 candidate topics that had been developed from the over 100 suggestions received from AHS members. Final items were selected based on commonly encountered situations in headache medicine associated with poor patient outcomes, low-value care or misuse or overuse of resources. The five recommendations were then approved by the AHS Executive Committee and Board of Directors.

“AHS has shown tremendous leadership by releasing its list of tests and procedures they say are commonly done in migraine and headache treatment, but aren’t always necessary,” said Richard J. Baron, MD, president and CEO of the ABIM Foundation. “The content of this list and all of the others developed through this effort are helping physicians and patients across the country engage in conversations about what care they need, and what we can do to reduce waste and overuse in our health care system.”

Over the next year, more than 30 other specialty society partners have released or will release Choosing Wisely lists, including:

• September 4, 2013 - AMDA – Dedicated to Long Term Care Medicine
• September 4, 2013 - American College of Surgeons
• September 4, 2013 - Commission on Cancer—a multidisciplinary program of the American College of Surgeons
• September 11, 2013 - American Academy of Orthopaedic Surgeons
• September 12, 2013 - Society of General Internal Medicine
• September 20, 2013 - American Psychiatric Association
• September 23, 2013 - American Society for Radiation Oncology
• September 24, 2013 - American Academy of Family Physicians**
• September 26, 2013 - American College of Medical Toxicology and the American Academy of Clinical Toxicology
• October 8, 2013 - American Association for Pediatric Ophthalmology and Strabismus
• October 9, 2013 - North American Spine Society
• October 12, 2013 - American Society of Anesthesiologists
• October 14, 2013 - American College of Emergency Physicians
• October 16, 2013 - American Association of Clinical Endocrinologists/The Endocrine Society
• October 27, 2013 - American College of Chest Physicians/American Thoracic Society (Pulmonary)
• October 27, 2013 - American College of Rheumatology*
• October 29, 2013 - American Academy of Dermatology
• October 29, 2013 - American Society of Clinical Oncology*
• October 31, 2013 - Society of Gynecologic Oncology
• December 4, 2013 - American Society of Hematology
• January 11, 2014 - American Association of Critical-Care Nurses/American College of Chest Physicians/American Thoracic Society/Society of Critical Care Medicine (Critical Care)
• February 3, 2014 - Society for Maternal-Fetal Medicine
• February 10, 2014 - Heart Rhythm Society
• February 24, 2014 - American College of Occupational and Environmental Medicine
• February 27, 2014 - American Geriatrics Society*
• February 28, 2014 - American Academy of Allergy, Asthma & Immunology
• TBD - American Association of Neurological Surgeons
• TBD - American Academy of Blood Banks
• TBD - American Society of Colon and Rectal Surgeons
• TBD - Society for Cardiovascular Magnetic Resonance

* Releasing a second list
** Releasing a third list

To date, over 80 national and state medical specialty societies, regional health collaboratives and consumer partners have joined the conversations about appropriate care. With the release of these new lists, the campaign will have covered more than 250 tests and procedures that the specialty society partners say are overused and inappropriate, and that physicians and patients should discuss.

The campaign also continues to reach millions of consumers nationwide through a stable of consumer and advocacy partners, led by Consumer Reports—the world’s largest independent product-testing organization—which has worked with the ABIM Foundation to distribute patient-friendly resources for consumers and physicians to engage in these important conversations. Choosing Wisely consumer partners include:
• AARP
• Alliance Health Networks
• Midwest Business Group on Health
• Minnesota Health Action Group
• National Business Coalition on Health
• National Business Group on Health
• National Center for Farmworker Health
• National Hospice and Palliative Care Organization
• National Partnership for Women & Families
• Pacific Business Group on Health
• SEIU
• The Leapfrog Group
• Union Plus
• Wikipedia

To learn more about Choosing Wisely and to view the complete lists and additional detail about the recommendations and evidence supporting them, visit www.ChoosingWisely.org.

About the American Headache Society
The American Headache Society (AHS) is a professional society of health care providers dedicated to the study and treatment of headache and face pain. The Society's objectives are to promote the exchange of information and ideas concerning the causes and treatments of headache and related painful disorders. Educating physicians, health professionals and the public and encouraging scientific research are the primary functions of this organization. AHS activities include an annual scientific meeting, a comprehensive headache symposium, regional symposia for neurologists and family practice physicians, publication of the journal Headache and sponsorship of the AHS Committee for Headache Education (ACHE). www.americanheadachesociety.org

About the ABIM Foundation
The mission of the ABIM Foundation is to advance medical professionalism to improve the health care system. We achieve this by collaborating with physicians and physician leaders, medical trainees, health care delivery systems, payers, policy makers, consumer organizations and patients to foster a shared understanding of professionalism and how they can adopt the tenets of professionalism in practice. To learn more about the ABIM Foundation, visit www.abimfoundation.org, read our blog blog.abimfoundation.org, connect with us on Facebook or follow us on Twitter.

About Choosing Wisely®
First announced in December 2011, Choosing Wisely® is part of a multi-year effort led by the ABIM Foundation to support and engage physicians in being better stewards of finite health care resources. Participating specialty societies are working with the ABIM Foundation and Consumer Reports to share the lists widely with their members and convene discussions about the physician’s role in helping patients make wise choices. Learn more at www.ChoosingWisely.org.


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