Australian and New Zealand Association of Neurologists
Recommendations from the Australian and New Zealand Association of Neurologists on faints, headache disorders, low back pain, migraine & narrowed carotid arteries. ANZAN aims to ensure that high standards of clinical neurology are practised in Australia and New Zealand by playing an active role in training, continuing education and encouragement of teaching and research.
Don’t perform imaging of the brain for non-acute primary headache disorders.
Headache is a common disorder with many potential causes. The primary headache disorders, which include migraine and tension headaches, account for the majority of headaches. Secondary headaches, which are those with underlying pathology (e.g., tumour, aneurysm, or giant cell arteritis) are far less common. Most patients presenting with headache will not have a serious underlying condition. Neuroimaging is not usually warranted for patients with recurrent migraine or tension headaches and a normal neurological examination. The likelihood of significant intracranial lesions on CT or MRI in this group ranges from 0.3% to 0.4%. Headache worsened by Valsalva maneuver, headache causing awakening from sleep, new headache in the older population, or progressively worsening headache may indicate a higher likelihood of finding significant abnormalities on CT or MRI as does the presence of abnormal neurological signs on examination.
- Morey SS. Headache Consortium releases guidelines for use of CT or MRI in migraine work-up. Am Fam Physician 2000;62(7):1699-701.
- Medical Advisory Secretariat. Neuroimaging for the evaluation of chronic headaches: an evidence-based analysis. Ont Health Technol Assess Ser 2010;10(26):1–57.
The ANZAN Council considered 12 clinical practices in neurology which may be overused, inappropriate or of limited effectiveness in a given clinical context. After choosing the top 5 items to prioritise, these were passed on to the appropriate subspecialty committees within ANZAN for comment and additional suggestions. The final list of the top 5 items chosen was compiled following a review of the evidence and the formulation of suitable recommendations and endorsed by the Council on 7th January 2016.
- 1 Don’t perform imaging of the carotid arteries for simple faints.
- 2 Don’t perform imaging of the brain for non-acute primary headache disorders.
- 3 Don’t perform epidural steroid injections to treat patients with low back pain who do not have radicular symptoms in the legs originating from the nerve roots.
- 4 Don’t use opioids for the treatment of migraine, except in rare circumstances.
- 5 Don’t routinely recommend surgery for a narrowed carotid artery (>50% stenosis) that has not caused symptoms.