Quality standard
Quality statement 3: Imaging
Quality statement 3: Imaging
Quality statement
People with tension-type headache or migraine are not referred for imaging if they do not have signs or symptoms of secondary headache.
Rationale
Referral for imaging solely for reassurance is most common in people diagnosed with tension-type headache and migraine. Therefore, the potential to reduce inappropriate referrals is greatest for these headache types. When healthcare professionals are confident about the diagnosis and classification of tension-type headache or migraine, imaging provides no more information and can lead to delays in diagnosis and treatment, and unnecessary anxiety for people.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that people with tension-type headache or migraine are not referred for imaging if they do not have signs or symptoms of secondary headache.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers ensure that systems are in place so that people with tension-type headache or migraine are not referred for imaging if they do not have signs or symptoms of secondary headache.
Healthcare practitioners do not refer people for imaging if they have tension-type headache or migraine and no signs or symptoms of secondary headache.
Commissioners ensure that they commission services that do not refer people for imaging if they have tension-type headache or migraine and no signs or symptoms of secondary headache.
People with tension-type headache or migraine are not referred for a brain scan if they do not have signs or symptoms of other conditions known to cause headaches.
Source guidance
Headaches in over 12s: diagnosis and management. NICE guideline CG150 (2012, updated 2021), recommendations 1.3.3 (key priority for implementation), 1.1.1 and 1.1.2
Definitions of terms used in this quality statement
Signs and symptoms of secondary headache
Signs and symptoms of secondary headache are:
-
worsening headache with fever
-
sudden-onset headache reaching maximum intensity within 5 minutes
-
new-onset neurological defect
-
new-onset cognitive dysfunction
-
change in personality
-
impaired level of consciousness
-
recent (typically within the past 3 months) head trauma
-
headache triggered by cough, valsalva (trying to breathe out with nose and mouth blocked) or sneeze
-
headache triggered by exercise
-
orthostatic headache (headaches that change with posture)
-
symptoms suggestive of giant cell arteritis
-
symptoms and signs of acute narrow-angle glaucoma
-
a substantial change in characteristics of their headache.
Criteria for which further investigations and/or referral may be considered for people who present with new-onset headache are:
-
compromised immunity, caused, for example, by HIV or immunosuppressive drugs
-
age under 20 years and a history of malignancy
-
a history of malignancy known to metastasise to the brain
-
vomiting without other obvious cause (for example a migraine attack).
[Adapted from NICE's guideline on headache in over 12s, recommendations 1.1.1 and 1.1.2]
Equality and diversity considerations
Some people may be anxious about not being referred for imaging and may need reassurance. Reassurance should take into account the needs of the individual, particularly any cultural needs, physical, sensory or learning disabilities, and of people who do not speak or read English. People should have access to an interpreter or advocate if needed.