This article originally appeared in the San Francisco Chronicle on March 26, 2014.
Headaches and migraines are among the most common reason Americans visit the doctor. And although medical guidelines say most of these patients don’t need brain scans, a new study shows many are getting them anyway – at a cost of about $1 billion a year.
Researchers at the University of Michigan analyzed four years’ of headache data from the National Ambulatory Medical Care Survey and concluded that, from 2007 through 2010, about 1 in 8 headache patients – mostly women – had a CT or MRI scan. The cost of these scans totaled $3.9 billion.
The number of headache patients receiving scans has risen over the past two decades, even though the American College of Radiology and other neurology doctor groups say scans aren’t necessary for most. Scans can reveal serious brain conditions, like tumors or aneurysms, but the researchers say those are behind only a tiny fraction of people’s headaches.
“Lots of guidelines say we shouldn’t do this – including ones from neurology and radiology groups – but yet we still do it a lot,” said Dr. Brian Callaghan, the University of Michigan neurologist who led the study. “This is a source of tremendous cost in health care without a lot of evidence to justify the cost.”
The scientists say there are other downsides to overusing brain scans, too. CT scans expose people to radiation, and MRIs can have false positives that lead to more unnecessary tests.
The researchers theorize that brain scans have increased because headache patients request them to rule out more serious conditions. Doctors want to reassure patients and also protect themselves legally. The study calls on headache patients not to push doctors for scans, and on doctors to use scans more judiciously.
Here are the numbers:
The number of U.S. doctor visits related to headache from 2007 through 2010. Nearly half of them were related to migraine.
The percentage of headache patients who were women. Eighty-eight percent were ages 18 to 65.
The percentage of the headache-related visits from 2007 through 2010 that resulted in doctors ordering an MRI or CT scan. But the Michigan scientists point to other research that shows only 1 to 3 percent of headache patients’ scans reveal that a tumor or abnormal blood vessel is causing the pain.
The percentage of headache-related doctor visits that resulted in brain scans in 1995. By 2010, this had risen to almost 15 percent.