Brain Scans for Headaches Overused and Costly to System

Neuroimaging tests for complaints of headaches and migraines are overused despite multiple recommendations against routine imaging, according to a research letter published in JAMA Internal Medicine.

“Lots of guidelines say we shouldn’t do this – including ones from neurology and radiology groups – yet we still do it a lot,” lead author Brian Callaghan, MD, MS, said in a release. “This is a tremendous cost in health care without a lot of evidence to justify the cost.”

Researchers from the University of Michigan Medical School used information gathered from the National Ambulatory Medical care Survey (NAMCS) to analyze all headache visits for patients 18 years or older between 2009 and 2010. They found that there were 51.1 million headache-related patient visits, with 25.4 million being recorded as migraines. Most patients (88 percent) were younger than 65 years. Seventy-eight percent of the total were women.

The majority of patient visits (55 percent) were to primary care physicians. Twenty percent of visits were to neurologists, 13 percent to other specialists and 12 percent to nonprimary care generalists. The researchers found that the rate of tests was higher if headache was listed as the primary diagnosis for the visit. Computed tomography or MRI was performed for 12.4 percent of all headache visits and 9.8 percent of migraine visits.

Imaging for headache and migraine is costly. “Total neuroimaging expenditures were estimated at $3.9 billion over four years, including $1.5 billion from migraine visits,” the authors wrote. “Between 1995 and 2010, neuroimaging utilization increased from 5.1 percent to 14.7 percent of all annual headache visits.” However, these costs do not include other costs, such as follow-up tests and any treatment that might be ordered if the scan finds something. Another concern regarding overuse of imaging is radiation exposure from the CT scans.

Callaghan suggests that patients who do have headaches listen to their physician regarding the utility of neuroimaging.