Implementation and Evaluation of Existing Guidelines on the Use of Neurophysiological Tests in Non‐Acute Migraine Patients

REVIEW ARTICLE


Paolo Rossi ¹ and Giorgio Sandrini ²

Affiliations: ¹ Headache Clinic and ² Headache Unit and University Centre for Adaptive Disorders and Headache, IRCCS “C Mondino Institute of Neurology” Foundation

ABSTRACT

Migraine diagnosis is based essentially on a detailed review of the patient’s history and symptoms and on the results of a careful clinical examination. In 2004, the European Federation of Neurological Societies (EFNS) published guidelines on the use neurophysiological tests and imaging procedures in non‐acute headache patients. According to these guidelines, neurophysiological tests are not helpful in headache diagnosis and should be recommended only in highly selected cases. Recently, we evaluated the impact of the EFNS recommendations in a cohort of Italian physicians. This study identified several critical areas for improving the production, dissemination, and implementation of these guidelines. First, the guidelines had an optimal diffusion among headache specialists and a very limited diffusion among neurologists and general practitioners (GPs), suggesting the need to improve the strategy for the diffusion of these guidelines among non‐headache specialists. Second, the physicians aware of the EFNS guidelines recommended neurophysiological tests to migraine patients less frequently and more appropriately than physicians who were not aware of them. This indicates that the guidelines may help to prescribe neurophysiological tests to migraine patients properly, and the need to perform randomized controlled trials before drawing any conclusion about their potential to change physicians’ behavior. Finally, due to misconceptions regarding neurophysiological tests, we suggest that the guidelines should probably state more explicitly that neurophysiological tests do not have the capacity to discriminate between migraine and secondary headaches, migraine and primary headaches, and are not useful to confirm the diagnosis of migraine or for orienting toward an appropriate recommendation of a neuroimaging procedure.

Keywords: neurophysiological tests, migraine, guidelines, diagnosis
Correspondence: Paolo Rossi, Headache Clinic, INI Grottaferrata, Via S Anna snc, 00046, Grottaferrata (Rome), Italy. Tel: (39)‐0694‐285259; Fax: (39)‐0694‐285243; e‐mail: paolo.rossi90@alice.it