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