American Headache Society

View all recommendations from this society

Released November 21, 2013

Don’t perform neuroimaging studies in patients with stable headaches that meet criteria for migraine.

Numerous evidence-based guidelines agree that the risk of intracranial disease is not elevated in migraine. However, not all severe headaches are migraine. To avoid missing patients with more serious headaches, a migraine diagnosis should be made after a careful clinical history and an examination that documents the absence of any neurologic findings such as papilledema. Diagnostic criteria for migraine are contained in the International Classification of Headache Disorders.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Headache Society (AHS) Board of Directors approved the creation of a task force to lead work on the Choosing Wisely® campaign. The task force consisted of: Elizabeth Loder, MD, MPH, (AHS President), 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.

The task force met twice by conference call to review the suggestions and choose items for further development, and then communicated electronically during the development and approval process. 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.

The AHS disclosure and conflict of interest policy can be found at:


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Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.  Neurology. 2000 Sep 26;55(6):754–62.

Neuroimaging for the evaluation of chronic headaches: an Evidence-based analysis. Ont Health Technol Assess Ser. 2010;10(26):1–57.

Headache Classification Subcommittee of the International Headache Society. International classification of headache disorders. Cephalalgia. 2004 Sep 1;4(1):1–151.