Question these procedures

WASHINGTON – The American Academy of Neurology (AAN) is releasing a list of five tests, procedures, and treatments that doctors and their patients should question as part of the “Choosing Wisely” campaign by the American Board of Internal Medicine (ABIM) Foundation. The list is published in the February 21, 2013, online issue of Neurology, the medical journal of the American Academy of Neurology. Sixteen other medical societies are also releasing their lists.

Choosing Wisely is an initiative endorsed by the AAN and 33 other medical specialty societies intended to spark conversations between physicians and patients about what care is appropriate for their condition, avoiding unnecessary tests and procedures.
“With one in six people affected by a brain disease, such as headache, multiple sclerosis, and stroke, our goal is to have patients discuss our Choosing Wisely recommendations regarding medical procedures, therapies, and tests with their neurologists,” said Bruce Sigsbee, MD, FAAN, president of the American Academy of Neurology.

“A broad range of neurologists reviewed the evidence that contributed to these recommendations, aimed at helping other neurologists and their patients make informed decisions based on a patient’s individual situation,” said lead author Annette Langer-Gould, MD, PhD, with Southern California Kaiser Permanente Medical Group and a member of the AAN.

The five recommendations are:
Don’t perform electroencephalography (EEG) for headaches. Recurrent headache is the most common pain problem, affecting up to 20 percent of people. The recommendation states that EEG has no advantage over clinical evaluation in diagnosing headache, does not improve outcomes, and increases costs.

Don’t perform imaging of the carotid arteries in the neck for simple fainting without other neurologic symptoms. Fainting is a frequent complaint, affecting up to 40 percent of people during their lifetime. Carotid artery disease does not cause fainting but instead causes focused neurologic problems such as weakness on one side of the body. Due to this, carotid imaging will not identify the cause of the fainting and increases cost.

Don’t use opioid or butalbital treatment for migraine except as a last resort. Opioid and butalbital treatment for migraine should be avoided because more effective, migraine-specific treatments are available. Frequent use of opioid and butalbital treatment can worsen headaches. Opioids should be used only for those with medical conditions preventing the use oNew Balance