Overuse of Imaging for the evaluation of primary headache

Measure Purpose: Reduce unnecessary use of neuroimaging for atraumatic primary headache disorders

NOTE: This is an inverse measure. A lower score means you're providing higher quality care. 

The numerator: Patients for whom imaging of the head (Computed Tomography (CT) or Magnetic Resonance Imaging (MRI)) is obtained for the evaluation of primary headache when clinical indications are not present

*See full specifications for additional details

is divided by

The denominator: All patients with a diagnosis of primary headache*

There are allowable exclusions for this measure:

• Head trauma
•  New or change in headache above 50 years of age
• Abnormal neurologic 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 pre-school children or younger (<6 years of age)
• New onset headache in pediatric patients with disabilities for which headache is a concern as inferred from behavior
• Occipital headache in children

Key Phrases

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

• CT brain performed
• MRI brain performed
• Imaging not recommended

Measure Calculation Example

Dr. Walsh had 100 patients with a primary headache disorder between January 1 and December 31. This is the denominator. One patient had head trauma, five had thunderclap headaches, five had an abnormal neurologic exam, and one had trigeminal pain. These 12 (1+5+5+1) patients are removed from the measure.

Of the remaining 88 patients, 50 did not have advanced brain imaging ordered. That leaves 38 patients who had imaging inappropriately ordered. This is the numerator.

Quality of care = (88-50)/(100-12). Dr. Walsh has a score of 43% for this measure.