Overuse of Imaging in Primary Headache

Measure Purpose: To reduce unnecessary imaging for primary headache patients

The numerator: Patients for whom imaging of the head (CT or MRI) is obtained for the evaluation of primary headache when clinical indications* are not present during the measurement period.

*If a clinical indication is present, patient would not meet the measure. Indications that warrant imaging include:

• Head trauma
• New or change in headache over 50 years of age
• Abnormal neurological exam
• Thunderclap headache
• Headache radiating to the neck
• Trigeminal pain
• Persistent and positional headaches
• Temporal headaches in patients over 55 years of age
• New onset headache in preschool children or younger (<6 years of age)
• New onset headache in pediatric patients with disabilities for which headache is a concern as inferred by behavior
• Occipital headache in children

is divided by

The denominator: All patients seen for the evaluation of primary headache

Exclusions: None

Key Phrases

Examples of key phrases you might use to meet this measure:

• CT brain performed
• MRI brain performed

Measure Calculation Example

Dr. Ricci saw 100 patients with primary headache between January 1 and December 31 of the measurement year. This is the denominator. Five of those patients had a thunderclap headache, two had abnormal neurological exams, and one had trigeminal pain. These patients do not count towards the numerator.

Of the remaining 92 patients, ten had a CT performed and one had an MRI performed. This is the numerator.

Quality of care =11/(100-8). Dr. Ricci has a score of 11% for this measure.

NOTE: a lower score is more desirable for this measure