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Literature reviews underpin the majority of research projects in the health sciences, and yet relatively little analysis has been published as to the most appropriate method to identify relevant literature, outside of specialist information journals. The method of applying keyword search queries to bibliographic databases using Boolean logic dominates literature reviews due to its easy application to the major online databases. However, it is recognised increasingly as being problematic where the research question cannot be clearly defined or requires an element of exploration, due to its reliance on author’s use of titling and keywords and is unable to identify topics other than those defined in the search query. This paper discusses the relative merits of a systematic citation searching approach as both an alternative and a concurrent method to keyword searching. A method of citation searching, both forwards and backwards, which is iterated to form a closed loop solution, is discussed. An illustrative example is presented of both methods, applying them to the topic of the UK National Institute for Health and Care Excellence (NICE) cost-effectiveness threshold. The case study finds the citation searching approach dominates the traditional keyword searching approach, finding 76 papers of relevance, including all 15 found by the alternative approach. Conceptually, and in the example presented, it is demonstrated that the proposed method can represent a dominant strategy to the more traditional approach in some situations, highlighting that, wherever possible, it is preferential to employ multiple methods of searching. However, it is clear that a better understanding is required as to how we can most efficiently search the ever-growing sea of literature.