The committee reviewed the items via email and in person discussions, and reached consensus about the five to undergo further development. These items were selected based on situations commonly encountered in headache medicine that were associated with poor patient outcomes, low value care, or documented overuse or misuse of resources. In accordance with ABIM guidelines for list development, individual RXDX-106 cost committee members developed draft

recommendations for each of the five items, along with supporting evidence statements. Among other things, the ABIM guidelines specified that each item should be “presented as a single, action-oriented sentence” no more than 15 words long. Evidentiary statements of less than 75 words were to follow each GS-1101 mouse recommendation to give a brief overview of the “evidence and thinking behind the recommendation. The draft recommendations were reviewed and discussed by the full committee. The committee considered multiple iterations of each recommendation and reached consensus on a final list of five. This proposed list was submitted to the ABIM Foundation, which sent it to two outside physician reviewers who provided feedback on the list. Based on suggestions

from these reviewers, minor revisions and changes in wording were made to several items on the list. The AHS executive committee and board of directors then unanimously approved the five recommendations. Thirty-six AHS members suggested over 100 candidate items for the list.

The overuse or misuse of imaging studies for headache was the most commonly mentioned problem. The vast majority of these responses identified overuse of plain computed tomography (CT) scans of the head as the problem, with some mentioning that these should only be used if intracranial selleck kinase inhibitor hemorrhage is suspected. Overuse of plain skull films, sinus films, and cervical spine imaging were also nominated as candidate items for the list. Many of the responses were similar or identical. Consolidation resulted in a list of 11 items (Table 1). The final five recommendations were chosen from this list (Table 2). They are listed below, followed by the evidentiary statement that will be published after the recommendation, and commentary providing a more detailed explanation and review of the evidence supporting each statement. 1.  Don’t perform neuroimaging studies in patients with stable headaches that meet criteria for migraine. Numerous evidence-based guidelines agree that the risk of intracranial disease is not elevated in migraine. However, not all severe headaches are migraine. To avoid missing patients with more serious headaches, a migraine diagnosis should be made after a clinical history and an examination that documents the absence of any neurologic findings, such as papilledema. Diagnostic criteria for migraine are contained in the International Classification of Headache Disorders.