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U.S. Headache Sufferers Get $1 Billion Worth of Brain Scans Each Year

Authors find that 12% of doctor visits for headaches result in a scan

One in eight visits to a doctor for a headache or migraine end up with the patient receiving a brain scan, at a total cost of about $1 billion a year, a new study from the University of Michigan Medical School finds.

Several national guidelines specifically discourage scanning the brains of patients who complain of headache and migraine. But the new study shows that the rate of brain scans for headache has risen, not fallen, since the guidelines came out. This may mean that patient demand for scans drives much of the cost, according to the report.

The researchers suggest that better education of the public, and insurance-plan designs that ask patients to pay part of the cost based on the likely value of the scan for them, may be needed to reduce unnecessary use and spending.

The research, published in JAMA Internal Medicine, used national data on headache-related doctor visits and neuroimaging scans by people over 18 years of age, and calculated estimated total costs across multiple years.

In all, 51.1 million headache-related patient visits occurred between 2007 and 2010 — nearly half of them related to migraine. Most of the visits were by people under the age of 65, and more than three-quarters of the patients were women. In those same 4 years, 12.4% of these visits resulted in magnetic resonance imaging (MRI) or computed tomography (CT) scans of the brain.

The researchers estimated the total cost of the 4 years’ worth of scans at $3.9 billion, based on typical Medicare payments to doctors for imaging.

Previous research has shown that only 1% to 3% of scans of patients with repeated headaches find that a growth or blood vessel problem in the brain is to blame, the authors say. And many of the issues that scans reveal turn out not to pose a serious threat — or may not require treatment right away.

According to lead investigator Brian Callaghan, MD, MS, the fact that 14.7% of people who saw a doctor for headache or migraine in 2010 went on to have a brain scan would not be expected if guidelines were being followed.

He also says that the $1 billion a year estimate doesn’t include other costs, including follow-up tests and any treatment that might be ordered if a scan finds something. Moreover, CT imaging comes with radiation exposure that itself carries risks, while MRI scans are more costly and have a higher chance of finding things that turn out to be of no concern.

The bottom line for headache patients who think they might want to have a brain scan, says Callaghan: if the doctor treating your headache doesn’t think you need a scan, don’t push him.

Source: University of Michigan; March 17, 2014.

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