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Neuroimaging for headaches: high use and costs, despite guidelines.

By 11th June 2014No Comments

Alhough guidelines discourage MRI and CT use for routine headache and migraine, 12 percent of visits to a doctor for headaches result in a scan according to a recent study from University of Michigan Medical School (Callaghan BC et al Headaches and Neuroimaging: High Utilization and Costs Despite Guidelines. JAMA Intern Med. 2014 Mar 17. doi: 10.1001). The study used United States national data on headache-related doctor visits and neuroimaging scans on people over age 18 and calculated total costs involved. In all, 51.1 million headache-related patient visits occurred between 2007 and 2010 – nearly half of them related to migraine. The vast majority were by people under the age of 65, and more than three-quarters of the patients were women. In those same four years, 12.4 percent of these visits resulted in a brain MRI or CT, at a total cost of about $1 billion a year.

In fact, in the United States, several national guidelines for doctors specifically discourage scanning the brains of patients who complain of headache and migraine.
But the new study shows the rate of brain scans for headache has risen, not fallen, since guidelines for doctors came out. But past research shows that only 1 percent to 3 percent of scans of patients with repeated headaches find that a growth or blood vessel problem in the brain is to blame.

“Lots of guidelines say we shouldn’t do this – including ones from neurology and radiology groups ” says Dr Brian Callaghan,  the neurologist who led the study.

“In fact, the number of times that serious issues are found in scans in headache patients is about the same as that for a randomly chosen group of non-headache patients” he says.

But the fact that 14.7 percent of people who saw a doctor for headache or migraine in 2010 went on to have a brain scan would not be expected if guidelines were being followed, he added.