Brain scans remain "substantially overused" on patients who visit the doctor complaining of headaches and migraines, despite multiple guidelines recommending against their use, a new JAMA Internal Medicine study says. Physicians must be vigilant about having conversations with patients about the risks, neurologists say.
Of more than 51 million U.S. patients who visited a primary-care physician, neurologist or other specialist for a headache, just more than 12% received an MRI or CT scan, according to the study which analyzed National Ambulatory Medical Care Survey data for all headache visits for patients 18 and older between 2007 and 2010. The data also found that of the more than 25 million who presented with a migraine, nearly 10% had undergone an imaging test. Use of neuroimaging was higher if the headache or migraine diagnosis was listed as the primary reason for the visit. During the four-year period, spending on the tests was estimated at $3.9 billion, according to the study.
“We were very surprised by the magnitude at which these tests were ordered,” said study author, Dr. Brian C. Callaghan, assistant professor of neurology at the University of Michigan. The trend since the mid-1990s has been that physicians increasingly kept ordering the tests, Callaghan says, despite evidence-based guidelines. “This is a big problem and something we need to take very seriously,” he said.