One of the nation’s leading experts on migraine headaches agrees that brain scans for headaches are often unnecessary.
Dr. Andrew Charles is the Director of the Headache Research and Treatment Program at UCLA.
He was responding to a new study published in JAMA Internal Medicine and reported here at the National Pain Report. Researchers found that in over 51 million headache related visits to physicians, one of our eight resulted in an MRI or CT Scan at the cost of $1 billion a year.
“This is an important study that provides strong evidence in support of what most neurologists and headache specialists already know: the majority of scans ordered for headache patients are unnecessary,” said Charles. “The reasons are complex and overlapping.”
Dr. Charles told us why he believes so many patients have unnecessary scans:
- Physicians commonly practice defensive medicine — they perceive that it is better to order a scan that they are confident will be normal rather than risk the extraordinarily small chance that it will abnormal and they might risk litigation.
- Patients have trouble believing that such severe pain and disability can be caused by something that doesn’t show up on a scan. They expect (and sometimes demand) that their physician will order a scan, and are not satisfied if it isn’t.
- In a small percentage of cases, physicians may have an incentive to order scans, because they have a financial relationship with the companies and individuals that do the scans and interpret them.
- It is much easier and less time consuming for a physician to simply order a scan than to take the time to explain to a patient that it is not necessary.
“In a world of limitless resources, this would all be fine — the scans aren’t known to be harmful (although some might argue with this, particularly for CT scans). But resources are limited,” Charles said in an email to National Pain Report.
“Imagine if all of the money spent on unnecessary scans was instead spent on research to find better therapies for patients with headache, and on better care for the extraordinary number of patients with these disorders. We could be doing much better than we are now. This is an issue that patients and care providers need to tackle together.”
While new national guidelines for doctors already discourage scanning patients’ brains who complain of headache and migraine, researchers have found that the rate of brain scans for headaches has actually risen.
“The unfortunate reality is that with current imaging technologies, the overwhelming majority of patients with headache have no identifiable abnormality on CT or MRI scans. Perhaps in the future we will develop imaging approaches that will be better able to help us manage patients with headache, but we are simply not there yet,” Charles added.