Many medical specialty groups of doctors have been coming out with “Choosing Wisely” campaign where they recommend avoiding five things in their field. Headache specialists just came out with their own list of items that offer low-value and can be even harmful. The American Headache Society surveyed its members to develop a candidate list of items of low-value care in headache medicine. Then, a committee reviewed the literature and the available scientific evidence about the candidate items on the list and by consensus came up with a final list of five items. The five recommendations are: (1) don’t perform a brain scan (MRI or CAT) in patients with stable headaches that are typical migraines; (2) don’t perform CAT scan for headache when MRI scan is available, except in emergency settings (MRI is much more informative and does not subject the patient to radiation); (3) don’t recommend surgical procedures for migraine, unless it is a part of a clinical trial (several types of surgery are being promoted with little scientific evidence that they are safe and effective); (4) don’t prescribe opioids (narcotic drugs, such as codeine, Vicodin, Percocet) or butalbital-containing medications (Fioricet, Fiorinal, Esgic) as a first-line treatment for recurrent headache disorders because these drugs are often ineffective, can worsen headaches and can cause addiction; and (5) don’t recommend prolonged or frequent use of over-the-counter pain medications for headache. I would stress that the last item is particularly important in regard to caffeine-containing drugs, such as Excedrin and Anacin, while ibuprofen, naproxen, and acetaminophen are much less likely to cause medication overuse (rebound) headaches. Aspirin sometimes can actually prevent headaches from becoming more frequent or chronic (I admit that as a developer of Migralex I am biased in favor of aspirin, but scientific data supports this).
