Does a head CT scan compared to no head CT scan change the management of a child with migraine?
Plain language summary from the office of evidence based practice: Based on moderate quality evidence, the Migraine in the ED CPG team makes a strong recommendation against obtaining a CT scan for a refractory migraine. The Practice Parameter of the American Academy of Neurology (AAN) (Lewis & Dorbad, 2000) is the basis of our recommendation. We concur with AAN and recommend against obtaining a CT scan on a routine basis in children with recurrent headaches and normal neurological exam. However, exceptions are made for children with abnormal neurological exams and children with recent onset of severe pain, or change in the type of headache.
Lewis & Dorbad, (2000) published a Practice Parameter for the evaluation of children and adolescents with recurrent headaches. The AGREE II (Brouwers et al., 2010) tool was used to assess the methodological vigor and transparency of the Practice Parameter. The Practice Parameter was assigned a score of 5 (range: 1-7; higher is better).
The major weaknesses of the AAN Practice Parameter are:
Limited stakeholder involvement
Process of developing the Practice Parameter is not clearly described
Role of competing interests are not clearly described
See Appendix A for the full Critically Appraised Topic (CAT).