CT, MRI overused for headaches

Visits to a doctor or emergency room for a headache or migraine are resulting in too many brain scans at a significant cost to healthcare systems, according to researchers from the University of Michigan Medical School.

Brian Callaghan, a University of Michigan neurologist, and colleagues reported in a research letter published in JAMA Internal Medicine that one in eight medical visits for headaches result in a scan at a total cost of about $1 billion per year.

In the letter, the researchers pointed out that the amount of neuroimaging that takes place during outpatient headache visits is at odds with guidelines that recommend against routine neuroimaging because in those cases a serious intracranial pathologic condition is an uncommon cause.

In fact, according to the researchers, only about 1 to 3 percent of scans of patients who present with frequent headaches find any kind of issue in the brain that is to blame.

"There's solid research showing that the number of times you find serious issues on these scans in headache patients is about the same as that for a randomly chosen group of non-headache patients," Callaghan said in an announcement. "And a lot of the things we find on such scans aren't necessarily something we will do something about." 

The "magnitude" of neuroimaging, according to the researchers, suggests "considerable overuse."

According to Callaghan and his colleagues, 51.1 million headache-related patient visits occurred between 2007 and 2010, with about half related to migraine symptoms. About one-eighth (12.4 percent) resulted in brain MRI or CT scans.

The researchers estimated that the cost of those scans, based on typical Medicare payments for these procedures, was $3.9 billion over the four years of the study.

"This is a conservative cost estimate based on what Medicare would pay for these tests," Callaghan said. "CTs and MRIs are commonly ordered for headache and migraine, and increasing over time, despite the fact that there are rare circumstances where imaging should be used. Lots of guidelines say we shouldn't do this--including ones from neurology and radiology groups--but yet we still do it a lot. This is a source of tremendous cost in health care without a lot of evidence to justify the cost,"

This isn't the first study to suggest that advanced imaging is being overutilized in the case of patients with headaches. Last July, FierceMedicalDevices reported on a study published in Pediatrics that found overuse of CT scans in children who complained of headaches.

To learn more:
- see the research letter in JAMA Internal Medicine
- check out the announcement from the University of Michigan
- read the article in FierceMedicalDevices

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