Headache sufferers in the U.S. get $1 billion worth of brain scans annually — a tremendous waste of money and resources, according to a new study from the University of Michigan Medical School.
Dr. Brian Callaghan, a neurologist and lead author of the study, said in a press release that MRI and CT-scan rates have risen significantly in spite of clear guidelines discouraging physicians from ordering the scans for routine procedures. One in eight visits for headache or migraine now ends with a brain scan. 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," he said.
"Lots of guidelines say we shouldn't do this — including ones from neurology and radiology groups — but yet we still do it a lot,” he continued. “This is a source of tremendous cost in health care without a lot of evidence to justify the cost.”
The study, which is published in the journal JAMA Internal Medicine, used data on headache-related doctor visits between 2007 and 2010. Over 52 million cases were identified. The researchers then examined the rate of neuroimaging scans within this set.
Callaghan and colleagues found that 12.4 of these visits involved some form of brain scan. However, past research has shown that only one to three percent of these scans reveal abnormalities like growth or blood vessel problems. And even when they do, abnormalities do not necessarily warrant medical attention.
"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 explained. "And a lot of the things we find on such scans aren't necessarily something we will do something about."
Excessive neuroimaging may also have lasting consequences for the patients themselves. CT-scans, for example, deliver 100-500 times more radiation than x-rays.
In an email to Medical Daily, Callaghan said that the trend may have several causes. First, doctors may order a brain scan to ease a patient’s fear of aneurysms, cancers, and other serious neurological issues. Even if a patient doesn’t meet the conditions set forth in the guidelines, physicians may still grant the request in order to protect themselves legally.
Widespread accessibility to advanced medical technologies such as MRI could also explain the increase in scans. “The bottom line for headache patients who think they might want to have a brain scan: if the doctor treating your headache doesn't think you need a scan, don't push them,” he said.
Source: Callaghan BC, Kerber KA, Pace RJ, Skolarus LE, Burke JF. Headaches and Neuroimaging: High Utilization and Costs Despite Guidelines. JAMA Internal Medicine. 2014.