Brain Scans May Be Too Common for Headaches

Headache doctor visits with neuroimaging like CT and MRI common but may be overused

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) When headaches reoccur, patients may worry that something serious is at play. Doctors might use brain scans on these patients to look for trouble, but this practice may be overused, says a new study.

Neuroimaging methods allow physicians to get a closer look at the structure or functioning of the brain and can alert doctors to serious problems. But these serious problems are rarely to blame for headaches, according to the researchers behind this new study.

These researchers found that neuroimaging has been fairly common practice and possibly overused during doctors' visits related to headaches. They also found that the practice has cost billions of dollars each year in the US.

"Tell your doctor about sudden, extremely painful headaches."

According to the authors of this study, which was led by Brian C. Callaghan, MD, MS, of the Department of Neurology at the University of Michigan Health System in Ann Arbor, although most headaches are not caused by serious conditions, they may be a source of concern for patients and doctors.

Dr. Callaghan and team explained that significant problems are found during neuroimaging scans in only around 1 to 3 percent of patients with chronic headaches, leading many guidelines to recommend against the scans as routine care for headaches. These researchers aimed to explore how often the scans actually have been used.

Using data from the National Ambulatory Medical Care Survey (NAMCS), Dr. Callaghan and team looked for instances of doctor visits for headaches in patients aged 18 or older between 2007 and 2010. The researchers then identified when these visits led to neuroimaging, which included computed tomography (CT) or magnetic resonance imaging (MRI).

In total, 51.1 million doctor visits for headaches were identified during this time, 25.4 million of which were visits for migraines.

The researchers found that 88 percent of these patients were under 65 years old, and 78 percent were female.

From 2007 to 2010, neuroimaging was used in 12.4 percent of all headache visits and 9.8 percent of visits for migraines.

Dr. Callaghan and team estimated that the total money spent on these neuroimaging scans during this time was $3.9 billion. For specifically migraine visits, the expenses were estimated at $1.5 billion.

Using older NAMCS data from 1995 to 2000 and 2005 to 2010, the researchers also looked for changes in rates of scans for headaches. They found that the use of neuroimaging increased from 5.1 percent of all headache visits in 1995 to 14.7 percent of headache visits in 2010.

Dr. Callaghan and team noted that since several guidelines recommend against routine use of neuroimaging, and since serious issues that these scans are used to discover are rarely the source of headaches, this study revealed a possible overuse of neuroimaging for headaches.

"Given that headache neuroimaging is common, costly, and likely substantially overused, interventions to curb utilization of these tests have the potential to substantially reduce health care expenditures while improving guideline concordance," the study's authors wrote.

Jordan Rosenblum, MD, Professor and Medical Director of Neurointerventional Program and Neuroradiology at Loyola University Health System near Chicago told dailyRx News, "It’s helpful for both the patient and the physician to have this type of documentation so they may know that the yield from neuroimaging results is low in patients with a normal neurological examination."

Dr. Rosenblum continued to say, "Neuroimaging is not always needed, not only because of the cost and inconvenience, but if incidental findings are discovered, they may lead to follow-up studies and unnecessary testing. These types of studies are valuable as they point out an apparent over-utilization in this population that’s very important."

Further research is needed to confirm these findings.

The study was published March 17 in JAMA Internal Medicine. No conflicts of interest were reported.

Review Date: 
March 17, 2014
Last Updated:
March 24, 2014