Brain Scans for Headaches Often Unnecessary

Brain Scans for Headaches Often Unnecessary

Patients who see a doctor for a migraine or headache often wind up getting costly brain scans that are unnecessary and may expose them to high levels of radiation, according to a new study published in JAMA Internal Medicine.

In an analysis of over 51 million headache related visits to physicians, researchers at the University of Michigan Medical School found that one out of eight visits resulted in an MRI or CT scan, at a total cost of about $1 billion a year.

bigstock-Dramatic-black-and-white-portr-35649329Many of the brain scans were probably unnecessary, according to researchers, because of the very low odds that serious medical issues would be found in the patients’ brains.

“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 Brian Callaghan, MD, the UM neurologist who led the team performing the study.

“And a lot of the things we find on such scans aren’t necessarily something we will do something about.”

New national guidelines for doctors already discourage scanning the brains of patients who complain of headache and migraine. But researchers found that the rate of brain scans for headache has risen, not fallen, since the guidelines came out.

“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,” said Callaghan.

“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.”

A standard brain CT scan costs about $340, according to HealthCareBlueBook.com. One with a contrast agent to make a clearer image costs about $840. A standard brain MRI image costs about $660 and one with a contrast agent about $970. The costs don’t include charges for subsequent treatments that may be prompted by uncertain results.

The Choosing Wisely campaign, which encourages physicians to order fewer medical tests, says a brain scan “rarely shows why a headache occurs or helps you manage its symptoms.” Yet many doctors order them anyway, often feeling pressured by patients who fear they may have a brain tumor, aneurysm or some serious medical problem.

Only 1% to 3% of scans of patients with repeated headaches find that a tumor or blood vessel problem in the brain is to blame. And many of the problems that scans find often turn out not to pose a serious threat.

The UM researchers suggest that better education of the public and insurance plans that require patients to pay more of the cost may be needed to reduce the unnecessary use of brain scans.

“Doctors typically don’t consider costs, and patients usually aren’t paying directly for these scans,” Callaghan said. “Insurers may require prior authorizations but still cover the scans if they are ordered.”

In addition to the cost of unnecessary brain scans, the procedures may also expose patients to more risk.

“The financial costs of neuroimaging for headaches are substantial. But the costs we should care most about as physicians are the unnecessary radiation and incidental findings that lead to unnecessary medical procedures and great anxiety on the part of our patients,” said Michael H. Katz, MD, in an editorial also published in JAMA Internal Medicine.

“Because professional guidelines themselves appear to have limited impact on ordering of neuroimaging, we need to focus more on educating our patients about headaches and the dangers of neuroimaging.”

CT scans of the head can deliver a radiation dose equivalent to 25 to 300 chest X-rays, according to a recent study.

“While the risk from any single exposure is uncertain, the harmful effects of radiation may be cumulative, so it’s best to avoid it when you can,” the Choosing Wisely campaign advises doctors.

Brain scans should only be ordered if the headache is sudden or explosive, is different from other headaches the patient has had in the past, is brought on by exertion, or is accompanied by fever, seizure, vomiting, a loss of coordination, or a change in vision, speech, or alertness.

Authored by: Pat Anson, Editor

There are 3 comments for this article
  1. Ron at 9:28 pm

    I ha a sinus surgery about 5 weeks ago and I’m getting this terrible headache. I went to my e.n.t. and he said it’s post sinus surgery, I don’t know what that means. I went to emergency and they prescribed me with morphine for 4 days and that didn’t help, so I went to the General hospital in emergency and they prescribed me with tramadol and said they can’t do anything. I am still having headaches in waves but sometimes my head feels really heavy. I ordered a medical report about my surgery and it’s stating in one of the line that there was a scar tissue along the skull base, which was carefully dissected with the use of navigation. Can you please tell me what they are saying in simple English.
    Thanks
    Ron Perimal

  2. Catherine Nichols Pogorzelski at 5:44 pm

    FYI the last MRI with contrast that I had done, with insurance covering it was $1,450 in 2007! That mean that is what my insurance company paid for on my behalf. I have had 7 of these over an 11 year period, 6 for “brain abnormalities” caused from UNDIAGNOSED CHRONIC LYME< I blame doctors for refusal to give me proper diagnosis, proper type and length of antibiotic treatment.

    I NOW have Systemic sclerosis, fibrosis of bowel, carotid stenosis, pancreatitis suppsoedly from Sjogren's, yet I suspect that I suffer with a NON-Nephrogenic Systemic Fibrosis.\, suffering contractures of hands and feet, repaeted bouts of chrnoic infections from Moraxella Catarrhalis, to Staph Aureus to Klebsiella Pneumonia, VERY COSTLY to have to go to an ER wehn a proper anitbiotic for a proper mength of time would have sufficed in kncoking out a Lyme infection that doctors say doesn't exist DESPITE POSITIVE TESTING!

    Blood and urine tests reveal I have HIGH amounts of Gadolinium in urine, some in blood and dermal biopsies have revealed Gadolinium and Focal Dermal FIbrosis with Increased mucin. I am being worked up for Eagle's syndrome, as I have elongated styloids. THe left side of my face is caving inward, as is my nose, a'la Michael Jackson.

    I have developed Thyroid Cancer and am awaiting surgery for that and the styloids. Of note, I WILL NEVER EVER SUBMIT TO ANOTHER MRI, EITHER WITH OR WITHOUT CONTRAST!
    IMO these agents should NEVER have received approval from the FDA as "safe," they are NOT by any means. APproved in 1988, NSF (Nephrogenic Systemic Fibrosis) was discovered in 1997, yet a warning albel was not put on until 1997, giving NSF a 20 YEAR FOOTHOLD into our health system, hence the RISE of "FIbromyalgia" as a diagnosed condition. Of those with a "FIBRO" diagnosis, one need only see if they've had even just ONE MRI with contrast, therein, lies your CAUSE & EFFECT!

    Do the research, Google, MRI TOXICITY, stay off attorney sites and USE the recent studies against the doctors who've ordered them; then hold GE & BAYER Accountable.
    It is even in our water supply and not being filtered out!
    Anthropogenic gadolinium as a micropollutant in river waters in Pennsylvania and in Lake Erie, northeastern United States [An article from: Chemie der … – Interdisciplinary Journal for Chemical] [HTML] [Digital]
    M. Bau (Author), A. Knappe (Author), P. Dulski (Author)

    tp://www.rc.unesp.br/igce/geologia/gl/beukes/Beukes_Course_%20Papers/BIFs/Bau_REE_papers/Kulaksiz&Bau_EPSL2007.pdf
    Detection of anthropogenic gadolinium in the Brisbane River plume in Moreton Bay, Queensland, Australia

    Here are recent FDA warnings on MRI's with contrast:
    http://www.auntminnie.com/index.aspx?sec=prtf&sub=def&pag=dis&itemId=106037&printpage=true&fsec=sup&fsub=mri
    what'd I tell u?
    GE/BAYER=POISON

    http://en.wikipedia.org/wiki/Gadolinium
    http://en.wikipedia.org/wiki/Sclerosis_(medicine)

    THIS CONDITION IS NOT ONLY HAPPENING IN THOSE WITH KIDNEY DISEASE OR IN THOSE WHO'VE HAD MORE THAN 1 OR MANY MRIS WITH CONTRAST-IT IS OUT THERE IT IS UNDER-DIAGNOSED AND NEEDS TO BE ADDRESSED!

    Wake up WORLD, you've been HAD, been POISONED BY GADOLINIUM USED IN MRI's by GE & BAYER and NEED testing…

    http://www.mayomedicallaboratories.com/test-catalog/alphabetical/G

    Gadolinium, 24 Hour, Urine
    Gadolinium, Dermal, Tissue (done if other tests are POSITIVE!)
    Gadolinium, Random, Urine
    Gadolinium, Serum
    Gadolinium/Creatinine Ratio, Random, Urine

  3. dave at 3:48 pm

    The people with headaches should decide whether they should have a scan.
    Although I have heard much made of unnecessary tests, having gone with people in pain many, many times to see their medical profession, it is clear to me busy doctors are so much in a rush to get to the next billable patient, that they neglect much of what is needed to do to assess and treat people in pain.
    Too many times a client tells me they go to the doctor with a headache-and that is what the doctor diagnoses them with. And so since there are over thirty comorbid conditions for migraine alone. Typically a person with “headaches” is misdiagnosed and underdiagnosed. For migraines, it is over 5 years before 50% of migraineurs receive an accurate diagnosis. They often neglect the cervicogenic headache that goes with many a migraine, as well. Cluster headaches, hemicrania continua, eagles syndrome-often misdiagnosed, as well.
    Bedside diagnosis, is advocated here by doctors who wish to be quick rather than thorough. Just as low back pain can be due to a muscle lymphoma they make light of a headache possibly being a tumor or giant cell arteritis. Here they clearly show that medicine is about- the paternalism of doctors who wish not to perfect their practice but to mislead their patients about having more information about their condition. Moreover, it is quite remarkable how many types of technological assessment devices aren’t used by doctors to assess pain. The reason why is clear- it takes time and education to learn how to use those tools properly- and doctors don’t have the time for that. . But unfortunately, bedside diagnosis for headaches has failed people suffering headaches.
    Neurologists have a long history of disliking people in pain- especially people with headaches. Medical textbooks as far back as 1840 document such.
    Doctors who treat people in pain perhaps need to step up research on wet biomarkers like CGRP or signal biomarkers like HEG. Nonetheless, for neurologists who underdiagnose and misdiagnose headaches to speakj out against scans is contrary to modern medicine and throws things back to the days of heroic medicine over a century ago.