Guidelines warn doctors against using brain scans for routine headache and migraine cases. Despite this, 12% of patients presenting with headache to a doctor are given scans, according to a study by researchers at the University of Michigan Medical School.
Since the guidelines discouraging the use of magnetic resonance imaging (MRI) and computed tomography (CT) scans for headache were published, scans have become more - rather than less - common for headache sufferers.
Headaches can sometimes be a symptom of a more serious illness, such as a brain tumor, aneurysm or arteriovenous malformation. Doctors might order an MRI or CT scan to put their patients' minds at ease, or even to protect themselves legally if their patient requests a scan.
But previous research has shown that only 1-3% of brain scans of headache patients uncover a malignant growth or problem with the blood vessels in the brain. Also, of these issues found by scans, many do not require immediate treatment.
"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," says Dr. Brian Callaghan, lead author on the study, which is published in JAMA Internal Medicine. "And a lot of the things we find on such scans aren't necessarily something we will do something about."
That the scans have become more widely used for headaches in the face of medical opinion could mean that the rise has been driven by patients putting pressure on their doctors. As such, Dr. Callaghan's team recommends better education for the public on headaches and the recommended applications of brain scans.
The team also suggests that redesigning insurance plans to require patients to pay part of the cost for the scan may discourage unnecessary use of this technology.
$1billion a year cost of scans is 'a conservative estimate'
As well as being costly, unnecessary scans can also have adverse effects on patients, such as exposure to radiation from CT imaging.
Using national data on neuroimaging scans and patients reporting headaches to their doctor, the researchers were able to calculate the estimated total costs.
Between 2007 and 2010, doctors received 51.1 million visits from patients with symptoms of headaches, half of which were migraine-related. Of these 51.1 million visits, 12.4% resulted in an MRI or CT scan. The total cost of the scans across these 4 years was $3.9 billion.
"This is a conservative cost estimate based on what Medicare would pay for these tests, says Dr. Callaghan, who adds that:
"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."
"But doctors typically don't consider costs, and patients usually aren't paying directly for these scans," Dr. Callaghan notes. "Insurers may require prior authorizations but still cover the scans if they are ordered."
As well as the estimated $1 billion a year in health care costs - which does not include the cost of follow-up tests - there are other adverse effects for patients having unnecessary scans. CT imaging, for instance, also carries a risk of side effects, due to the radiation exposure from the scan.
Ultimately, Dr. Callaghan's study advises patients that if their doctor does not believe they need a scan, then they should refrain from pushing the issue with them.
Recently, Medical News Today reported on the first device treating migraine headaches to secure the approval of the US Food and Drug Administration.
Written by David McNamee