Headache tests and treatment you do, and don't, need

Doctors recommmend choosing wisely to minimize health risks

Published: November 22, 2013 10:00 AM

If you suffer from headaches or migraines you may think you need a fancy test such as a CT scan to find the underlying cause. And you might want a powerful narcotic or sedative painkillers for relief. But doctors who specialize in headache care say that those tests and treatments are commonly overprescribed and have issued new recommendations to curb their use. Here’s why.

You risk unnecessary exposure to cancer-causing radiation by undergoing imaging studies such as CT scans for migraines and other types of headache, except in emergencies such as head trauma. Otherwise, MRI is better at detecting the most serious underlying causes of headache, such as lesions and tumors, plus there are no known biologic risks from MRI.

Narcotic opioid pain relievers and those that contain butalbital, a sedative, can become habit-forming or impair alertness. They also increase the risk that headache disorders will become chronic and make you more sensitive to pain. Both should be reserved only for people who can’t use or find relief with prescription migraine drugs called triptans or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, and generic) or naproxen (Aleve and generic), medications not associated with dependence or sedation.

Even if NSAIDs help your headache, guard against prolonged or frequent use. That can lead to an increase in headaches, resulting in “rebound” or “medication overuse headache.” With NSAIDS, overuse can also lead to gastrointestinal bleeding; with acetaminophen, it can result in liver damage, according to new recommendations by a task force of the American Headache Society published this week in the November-December 2013, issue of the journal Headache.

See a complete list of tests and treatments physicians and patients should question, created as part of the Choosing Wisely campaign to reduce waste and harm in medical care.

The recommendations contain valuable guidance to patients and physicians as they aim to curtail medication overuse headaches, an unfortunate consequence of overtreatment, says Consumer Reports' medical adviser Orly Avitzur, M.D. “Butalbital-containing drugs, in particular, can cause these types of rebound and make a bad situation even worse,” she said. “In my neurology practice, I see this frequently, and it can be difficult to wean patients off the regimens.”

Read more about medical treatments in Consumer Reports’ Best Buy Drugs for pain, including those that compare the effectiveness, safety, and price of NSAIDs and triptans for treating migraine headaches. And learn more about how to thwart different types of headache in our know your headache guide, including preventative nondrug strategies. When we surveyed 45,601 Consumer Reports subscribers online, for example, we found that some said chiropractic, massage, acupuncture, and yoga helped a lot.

—Doug Podolsky

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