Diagnostic Testing
Does a head CT scan compared to no head CT scan change the management of a child with migraine?
Plain language summary from the office of evidence based practice: Based on moderate quality evidence, the Migraine in the ED CPG team makes a strong recommendation against obtaining a CT scan for a refractory migraine. The Practice Parameter of the American Academy of Neurology (AAN) (Lewis & Dorbad, 2000) is the basis of our recommendation. We concur with AAN and recommend against obtaining a CT scan on a routine basis in children with recurrent headaches and normal neurological exam. However, exceptions are made for children with abnormal neurological exams and children with recent onset of severe pain, or change in the type of headache.
Synthesis:
Lewis & Dorbad, (2000) published a Practice Parameter for the evaluation of children and adolescents with recurrent headaches. The AGREE II (Brouwers et al., 2010) tool was used to assess the methodological vigor and transparency of the Practice Parameter. The Practice Parameter was assigned a score of 5 (range: 1-7; higher is better).
The major weaknesses of the AAN Practice Parameter are:
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Limited stakeholder involvement.
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Process of developing the Practice Parameter is not clearly described.
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Role of competing interests are not clearly described.
See Appendix A for the full Critically Appraised Topic (CAT).
These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.