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J Am Coll Radiol. 2019 Nov;16(11S):S364-S377. doi: 10.1016/j.jacr.2019.05.030.

ACR Appropriateness Criteria® Headache.

Author information

1
Children's National Health System, Washington, District of Columbia. Electronic address: MWhitehe@childrensnational.org.
2
Research Author, Children's of Alabama, Birmingham, Alabama.
3
Panel Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia.
4
Panel Vice-Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
5
Montefiore Medical Center, Bronx, New York.
6
Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada, Canadian Association of Radiologists.
7
Rush University Medical Center, Chicago, Illinois, Neurosurgery expert.
8
Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, Neurosurgery expert.
9
University of Kansas Medical Center, Kansas City, Kansas.
10
Einstein Healthcare Network, Philadelphia, Pennsylvania.
11
University of California San Diego Medical Center, San Diego, California.
12
Oregon Health & Science University, Portland, Oregon.
13
University of North Carolina School of Medicine, Chapel Hill, North Carolina, American Academy of Neurology.
14
Albany ENT & Allergy Services, PC, Albany, New York, American Academy of Otolaryngology-Head and Neck Surgery.
15
Walter Reed National Military Medical Center, Bethesda, Maryland.
16
UT Southwestern Medical Center, Dallas, Texas.
17
Columbia University Medical Center, New York, New York.
18
Specialty Chair, University of California San Diego Health Center, San Diego, California.

Abstract

Headache is one of the most common human afflictions. In most cases, headaches are benign and idiopathic, and resolve spontaneously or with minor therapeutic measures. Imaging is not required for many types of headaches. However, patients presenting with headaches in the setting of "red flags" such as head trauma, cancer, immunocompromised state, pregnancy, patients 50 years or older, related to activity or position, or with a corresponding neurological deficit, may benefit from CT, MRI, or noninvasive vascular imaging to identify a treatable cause. This publication addresses the initial imaging strategies for headaches associated with the following features: severe and sudden onset, optic disc edema, "red flags," migraine or tension-type, trigeminal autonomic origin, and chronic headaches with and without new or progressive features. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

KEYWORDS:

AUC; Angiogram; Appropriate Use Criteria; Appropriateness Criteria; CT; Headache; MRI; Migraine; Neuroimaging

PMID:
31685104
DOI:
10.1016/j.jacr.2019.05.030

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