Did Your Doctor Order Brain Imaging for Your Headache?

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Did Your Doctor Order an MRI for Your Headache?. Glow Wellness/Getty Images

The last time you went to see your doctor for a headache, did he order a CT or MRI of your brain? Did you question if it was really necessary?

Certainly, there are instances in which brain imaging is absolutely needed for a headache evaluation.  But some imaging tests ordered for headaches are unnecessary and inappropriate — and can lead to more harm than good.

Let's take a closer look at whether imaging is being over-utilized for headache complaints.

Overuse of Brain Imaging?

In a study in JAMA Internal Medicine, data was analyzed from the National Ambulatory Medical Care Survey. Results revealed that over 51 million headache sufferers visited a primary-care physician for an evaluation from 2007 through 2010. 25 million of these headaches were for migraines. Imaging of the brain with either a CT scan or MRI was done in 12.4% of all the headache visits and in 9.8% of the migraine visits, at an estimated cost of $3.9 billion. Overall, the use of brain imaging for headaches nearly tripled from 5.1% (of all yearly headache visits) in 1995 to 14.7% in 2010.

What Does This Mean?

So why are doctors ordering more brain imaging tests? Is it because they are lacking enough time to determine whether imaging is actually warranted? Do doctors order brain scans to reassure the patient and/or themselves? These are all good questions and warrant more thought.

The authors of this study stated, "Since 2000, multiple guidelines have recommended against routine neuroimaging in patients with headaches because a serious intracranial pathologic condition is an uncommon cause. Consequently, the magnitude of per-visit neuroimaging use found in this study suggests considerable overuse."

What are the Consequences of More Brain Imaging?

Of course, a scan should be done if there are headache warning signs or if your doctor is suspicious for something worrisome going on, like a brain tumor. But, the fact that more and more brain scans are being done— over 10% of all headache visits—suggests that doctors may be over-ordering.

Now, you might think to yourself: Isn't it better to be safe and get a brain scan to make sure there is nothing going on? Well, not exactly. There is a downside to getting unnecessary imaging. For one, it can be anxiety-producing. Scans are costly too. Moreover, it can lead to incidental findings, which may lead to further unnecessary follow-up and invasive procedures.

Final Thought

This is certainly a tricky topic. Over-ordering brain scans is not good, but we also don't want serious medical conditions missed or delayed in being diagnosed. As a patient, you can be proactive in your care by being thoughtful and asking your doctor for the reasoning behind their recommendations.

Sources

Callaghan BC, Kerber KA, Pace RJ, Skolarus LE, & Burke JF. Headaches and NeuroimagingHigh Utilization and Costs Despite Guidelines. JAMA Intern Med. 2014;174(5):819-821.

Clarke  CE, Edwards  J, Nicholl  DJ, & Sivaguru  A.  Imaging results in a consecutive series of 530 new patients in the Birmingham Headache Service. J Neurol. 2010;257(8):1274-1278.

Sempere  AP et al.  Neuroimaging in the evaluation of patients with non-acute headache. Cephalalgia. 2005;25(1):30-35.

Strain JD et al:  Headache. American College of Radiology. ACR appropriateness criteria.   Radiology 215. (suppl): 855-860.2000.

Wang  HZ, Simonson  TM, Greco  WR, & Yuh  WT.  Brain MR imaging in the evaluation of chronic headache in patients without other neurologic symptoms. Acad Radiol. 2001;8(5):405-408.

DISCLAIMER: The information in this site is for informational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for advice, diagnosis, and treatment of any concerning symptoms or medical condition.

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