Brain Scans Overused For Headache Exams, Despite Guidelines: Study

New research suggests that more than $1 billion is spent each year on brain scans, and the majority of the exams may be unnecessary. 

In a study published this week in the journal JAMA Internal Medicine, researchers indicate that the number of headache related procedures tripled over the last decade, rising from five percent of all doctor visits to nearly 15% of all visits.

Researchers from the University of Michigan Health System reviewed more than 51 million headache visits involving people older than 18 years of age, which were tracked in the national Healthcare Cost and Utilization Project (HCUP) database.

The visits took place from 2007 to 2010. The study revealed nearly one in eight doctor visits for an uncomplicated headache or migraine resulted in a magnetic resonance imaging (MRI) or computed tomography (CT) scan.

Despite national guidelines recommending against routine use of high powered brain scans, the use of scans is going up, not down. In fact, less than three percent of patients have significant brain abnormalities, calling for the use of brain scans.

More than 13 million brain scans were conducted each year over the course of the four year study. Half of the visits were patients who suffered from migraines, yet nearly 12% of the patients received an MRI or CT scan.

Dr. Brian Callaghan, assistant professor of neurology at the University of Michigan Health System and lead author, said the cost of the rise in demand for brain scans resulted in nearly $4 billion dollars over the study period.

Worrying Trend

At a cost of nearly $1 billion per year in potentially unnecessary brain scans, experts worry the trend will only continue. The majority of the scans are driven by patient demand, not medical necessity.

Furthermore, brains scans expose patients to harmful radiation, an amount patients often underestimate. A CT scan can expose a patient to radiation the equivalent of 25 to 300 chest x-rays.

Other risks of CT scans are often not adequately explained to patients before they undergo the procedure, a study published in 2013 revealed.

National initiatives, such as the “Choosing Wisely” campaign, funded by the ABIM Foundation in partnership with Consumer Reports, hope to increase awareness concerning the unnecessary prevalence of MRI and CT scans among headache and migraine sufferers.

Most people who opt for brain scans simply have a typical migraine or tension headache and don’t need the costly and potentially harmful procedure. The scans may also lead to false positives which prompt unnecessary treatment and increase a patient’s anxiety, often increasing the head pain, experts warn.

Other studies have also reported increases in CT scans over the past 18 years. The use of radiation involved scans tripled since 1996, according to a study published in the Journal of the American Medical Association.

Doctors say the increase places more patients at risk of radiation exposure, especially considering most patients only need a neurological exam to correctly diagnose and treat migraines.

The “Choosing Wisely” website warns patients to seek an MRI or CT scan if they have received an abnormal result from a neurological exam or a doctor can’t adequately diagnose the problem. Other warning signs may include experiencing a sudden or explosive headache, a headache that differs from others in the past, if it is brought on by exertion, or if it is accompanied by fever, seizure, vomiting, loss of coordination, change in vision, speech or alertness.