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Most Headache-Related Imaging Proves Unnecessary and Too Costly

Current guidelines discourage the use of MRIs and CT scans for routine headache and migraine care, yet 12% of visits to a physician for headaches result in a scan. This imaging costs about $1 billion a year, according to a new study at the University of Michigan Medical School.

“This is a conservative cost estimate based on what Medicare would pay for these tests,” said Brian Callaghan, MD, who led the study. “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.”

Dr. Callaghan and colleagues found that 1 in 8 visits to a health care professional for a headache or migraine result in imaging, and most of those are unnecessary. In fact, previous research has shown that only 1 to 3% of scans of patients with repeated headaches are the result of an abnormal growth or blood vessel problem in the brain. Additionally, many of the issues revealed by scanning are not a cause for serious concern or 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,” Dr. Callaghan said. “And a lot of the things we find on such scans aren’t necessarily something we will do something about.”

He also noted that substantial additional costs, including follow-up tests and treatment, are not included in the $1 billion figure. Additionally, he cautioned that CT scans expose patients to radiation. Although MRI scans are more costly, those images are more likely to find issues of no concern.

“But doctors typically don’t consider costs, and patients usually aren’t paying directly for these scans,” he added.

To curb the use of these imaging tests and the excess spending associated with them, the researchers suggest that improved patient education may be helpful, as well as insurance plans that require patients to pay part of the cost based on the likely value of the scan.

“If the doctor treating your headache doesn’t think you need a scan, don’t push them,” Dr. Callaghan said.

The research was published in the journal JAMA Internal Medicine.

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