Brain Scans for Headache: Unnecessary, Overused & Too Costly?
Even though no telltale signs of migraine show up in brain scans, they are usually part of the workup when someone first sees a doctor for head pain. MRIs and CT scans are not used to confirm a migraine diagnosis, but to rule out a life-threatening one, like a brain tumor or aneurysm.
Only a tiny percentage of headaches have an underlying issue that can be detected on a scan, but $1 billion each year is spent in the U.S. on scans for headache, according to a study published in JAMA Internal Medicine this week. The study also found that the frequency of brain scans for headache is on the rise.1
These findings contradict the guidelines that the American College of Radiology issued in 2012, which caution against brain scans for headaches unless a patient has specific risk factors or symptoms indicative of problems like a brain tumor or stroke. This recommendation is in part to reduce medical spending, but also to protect patients from radiation exposure and the battery of tests and worry that will ensue if the scan turns up a false positive.
Avoiding unnecessary radiation and unnecessary medical tests (and expenses) is logical and wise, but what about patients who are terrified that their headaches are indicative of a life-threatening condition?
We’re conditioned to think that severe, disabling headaches are the result of a brain tumor (even though they almost never are). In the absence of blood tests or scans to prove a person has migraine, patients often worry that their doctors missed something and migraine was the wrong diagnosis. MRIs or CT scans may be unnecessary, but they give patients peace of mind.
Is peace of mind the best use of medical tests and health care dollars? No, not rationally. So, tell me, how often does rationality come into play when someone thinks their life (or brain) is at stake?
Headache accounts for a quarter of all doctor visits. Some may take this to mean that headache is a common malady that’s no big deal. That belief is the very reason that headache accounts for so many trips to the doctor -- people tend to think that the only time head pain is disruptive or disabling is because it’s indicative of a brain tumor or something else life threatening.
Despite experts' recommendations and studies showing massive amounts of money spent on tests that show nothing is wrong, brain scans will continue to be used for headache until people understand that “no big deal” and “going to kill you” aren’t the only two types of headaches.
In my early days of diagnosis, I couldn’t rest without seeing visible proof that a brain tumor wasn’t causing my debilitating head pain. I’m pretty sure I’m in the majority. How about you? Have you had imaging done for migraine? Would you have accepted your diagnosis without it?
(Curious when imaging is recommended for headache? Check the American Headache Society's guidelines.)
How much has your migraine disease changed or evolved over time?