Imaging Can Be Such A Headache

CT and MRIs not necessary to diagnose headaches according to campaign

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Getting to the bottom of a headache can be a headache itself. Many turn to CT or MRI scans for answers. But a recent campaign says that may not be necessary.

A not-for-profit organization established by the American Board of Internal Medicine has joined with leading medical groups to develop lists of tests and procedures for patients to discuss with their physicians as part of a campaign called Choosing Wisely®.

The foundation stated that most headaches can be diagnosed with a neurological exam and review of medical history. Imaging should be reserved for cases where neurological exams or the headache itself are abnormal.

"Try self-care to manage a headache."

The campaign - which combined efforts from Consumer Reports, American Academy of Family Physicians and other entities - issued a document describing the nature of headache diagnosis, the risks involved with imaging and how to self-treat a headache.

According to Choosing Wisely®, most headaches can be diagnosed through a careful review of a patient’s medical history and a neurological exam. CT scans and MRIs normally do not reveal the cause and treatment course.

The authors of the document explained that there is no guarantee that any abnormalities found through imaging are the cause of the patient’s original pain. Finding and chasing issues that may not be the cause of pain can lead to unnecessary procedures that have their own recovery time.

The campaign highlights the risk of a scan finding an abnormality that is not the cause of the headache or any medical problem. In response to the scan, the patient may suffer from anxiety, require follow-up tests and treatment, be exposed to unnecessary radiation from the scan and incur expenses.

"CT scans offer high radiation doses," said Steven Kussin, MD, FACP, patient advocate and author of Doctor, Your Patient Will See You Now. "It’s felt that 2% of all cancers in the U.S. are in part related to a life long history of diagnostic radiation exposure."

Dr. Kussin explained to the dailyRx that the sensitive nature of X-rays often leads to incidental findings. He also explained that fear of malpractice actions sometimes encourage radiologists to chase these small abnormalities.

"This becomes a vicious cycle of tests, confirmatory tests, over diagnosis and over therapy," added Dr. Kussin.

HealthCareBlueBook.com lists the cost of a standard brain CT scan at $340 and a CT scan with a contrast agent to make the image clearer at $840. Standard brain MRIs cost about $660 and about $970 with a contrast agent.

Choosing Wisely® warns that there may be additional costs from treatments triggered by findings in the scan that may not improve the patient’s condition.

According to the campaign, patients should consider scans if they have abnormal results in their neurological exam or a doctor cannot diagnose their headaches.

"CTs are not needed if a full history and physical examination are performed and ‘red flag’ symptoms are excluded," advised Dr. Kussin

A scan may be needed if the headache is sudden or explosive, different from past headaches, brought on by exertion or accompanied by other symptoms like fever, seizure, vomiting, coordination loss or changes in vision, speech or alertness, advised Choosing Wisely®.

Choosing Wisely® noted that most headaches can be treated with just a few steps. Recommendations for self-care include:

  • Avoid triggers like bright lights for migraines, jaw clenching for tension headaches and to stay away from using tobacco
  • Manage stress with activities like meditation, yoga, stretching and relaxation
  • Get enough sleep
  • Consider medication

Dr. Kussin explained that more people are afraid of headaches than other conditions. Fear may lead them to take action when it is not needed.

"The fear of tumors, strokes and aneurysms is high," said Dr. Kussin. "Most people know a young victim of these diagnoses and the consequences that follow."

Reviewed by: 
Review Date: 
February 27, 2013
Last Updated:
March 12, 2013